Help understanding risks

[Fire559]

Hello all!
I have been lurking hear for awhile. You all have given me a better understanding of what to expect but am in need of some extra advice. I am a firefighter who was recently found to have a bicuspid aortic valve. Found at my annual physical to have murmur and then the valve issue with an aneurism of ascending aorta. Needless to say quite a shock and was put off on medical. I had the surgery Aug 9th. Other than a flutter issue that was fixed with ablation. Rehab went well and have been trying to return to work. My surgeon and cardio have both released me to full duty no restrictions but dept doc is saying no due to Coumadin. I did a lot of research prior to my surgery about valve choices and such. Was told that Coumadin would not be an issue to return to duty. So being 39 I opted for mechanical for longevity reasons. Now apparently they are having concerns about Coumadin! Wth! I am looking for any information related to risk factors and such. It seems the more I look, the more conflicting info I find. I understand the risk of head bleed increases due to the thinner after trauma but seems that most of the numbers I have found are for people over 60. And most of these people had other medical issues on top. Any help you can provide is appreciated. Thanks.

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[ski girl]

Welcome Fire! I too have been trying to get more info on my risk of bleeding due to warfarin (I'm 42 and got a mech valve 18 months ago) but everything I find is for oldies. Eventually I decided just to get on with my life and see what happens - several mountain bike crashes and one solid whack on my head later and I have not bled to death so I'm not so worried anymore.

If you can't find any info on real bleeding risks when you're not old and crumbly, is there any way around the problem by going above the dept doc with your clearance from the cardio and surgeon? They're certainly more quailified to know what your risks are with coumadin . . . .

 

[Guyswell]

My guess is that the real problem is with the fire department's liability if they allow you to work with this known risk factor (even though the risk may be pretty low). If you're injured on the job and/or unable to properly rescue someone due to a coumadin-related problem, it could be a big liability problem for the department. I wonder if this objection is due to legal concerns rather than medical concerns.

 

[pellicle]

Hi and welcome
I can only really speak for myself and I have not come across any pre/post warfarin studies on patients. So I can say for myself that my bleeding has not increased significantly after warfarin.

Just yesterday I wacked myself heavily when replacing a spring on my tilt-a-door and can't say that I bled or bruised any more than if I'd done it a year or two ago before warfarin.

my INR is 2.5

 

[pellicle]

Hi and welcome
I can only really speak for myself and I have not come across any pre/post warfarin studies on patients. So I can say for myself that my bleeding has not increased significantly after warfarin.

Just yesterday I wacked myself heavily when replacing a spring on my tilt-a-door and can't say that I bled or bruised any more than if I'd done it a year or two ago before warfarin.

my INR is 2.5

 

[JimL]

You are certainly safe to return to work, however, sometimes even professionals are ignorant about coumadin. For example, there are people who ought to know better who still think that because it's called a blood thinner, it actually does thin the blood -- and I supppose therefore the blood leaks out easier! Sometimes people still operate with the same kind of warnings that were in place many years ago when the only way you could tell you were taking too much coumadin was blood in the urine, perhaps an INR of 9.
I certainly wish you luck on returning to work! The only thing I can think of is to convince your local people that you are safe. Can you get okayed to train with them? You could consider getting cut so they can see that you don't bleed significantly longer than anyone else. However, I would not want to risk the head bleed...

 

[Jkm7]

You are certainly safe to return to work, however, sometimes even professionals are ignorant about coumadin. For example, there are people who ought to know better who still think that because it's called a blood thinner, it actually does thin the blood -- and I supppose therefore the blood leaks out easier! Sometimes people still operate with the same kind of warnings that were in place many years ago when the only way you could tell you were taking too much coumadin was blood in the urine, perhaps an INR of 9.

<snip>

My father was one of the 'pioneers' of coumadin. He was put on it in 1964 and there was no testing. As you say, his doctor would lower his dose when he showed blood in his urine. It's those patients who are the guinea pigs for the new drugs that make it safer later for those who follow. Though I lost him at a very young age, I am proud my father took the risk so others could profit. He died after being on the drug a little more than three years.


Fire,
There have been a few firefighters and police officers who were in the same situation as you currently are. Some managed to retain their positions but sadly others did not. I think the others are correct the Department is worried about potential liability. I do not remember the firefighters' posting names so it will be hard to find their posts on this forum but I will attempt a search. Maybe something they wrote might be helpful to you.

I send you all best wishes and sincerely hope you are able to return to your position.
Good luck.

Here is one link. I know there are others on Vr.org.

http://www.valvereplacement.org/for...-job!&highlight=firefighter+++coumadin+++work

 

[tom in MO]

It is real simple, if your INR is 2, your blood will clot in twice the time as if you had no warfarin, INR is 3, your blood will clot in three times the time. If your INR is 2.5, you will get ~2.5 times the amount of blood before clotting.

Where it gets impossible to judge risk is with the statistics and how they define death by warfarin. If you die of a thrombosis and are on warfarin, it is blamed on warfarin, even if the head trauma would have killed someone with a normal INR. For example, if someone on Warfarin gets hit in the head in a car accident and dies due to a clot...it's is countd as a warfarin death even if the blow would have killed them if they had a normal INR. The reason why is nobody really knows if the blow would have killed them anyway, but they are sure that warafarin helped them along.

Your dept doc is wrong. Get whomever is writing your warfarin script (e.g. your cardiologist) to write the dept doc a letter. If you are in a union, see your union rep, they may help. You may need to get a lawyer.

 

[Fire559]

Re: Help understanding risks

Appreciate all the replies. Ski girl I'm with you. Plan on doing all the same things I did before...just now I can do it better! I have been in contact with my union and a lawyer and they have been giving me some help with this. Guyswell i believe you are probably correct in what they are thinking but they are messing with my career and my families future! I was just curious if anyone on here had any other studies or info I might use. I was scared when I first found out about this but have to say you all have given me a new outlook with this. And you are right when the information anywhere varies from "don't walk outside without shoes" to "do what you want" I'm just trying to find any information I can to change their minds. Thanks to all.

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[Heart Of The Sunrise]

Hi Guyswell:

Well yesterday I committed to surgery on 3/18/13. I will be having the ON-X valve and ascending aorta conduit too. Small chance that I may need a pacemaker.
What can you tell me about the sound of the On-X?

Thanks, H.O.T.S

 

[pellicle]

It is real simple, if your INR is 2, your blood will clot in twice the time as if you had no warfarin, INR is 3, your blood will clot in three times the time. If your INR is 2.5, you will get ~2.5 times the amount of blood before clotting.

Thank you Tom. First time I have seen this explained simply

 

[tom in MO]

Well I had an epiphany when I first cut myself shaving. Usually takes 5 minutes for the blood to stop. I kept expecting it to stop in less than 10 min, little did I realize, with my INR of 2.5, it'll take more like 15 min. Frustrating, particularly when you have to take the sweet daughter to the bus stop in 20 min.

So now if I cut myself shaving, I sit down and watch TV for 15 min. The hardest part is putting pressure on something for those longer periods of time. Finger cuts, I use the gauze under a bandaid trick to put more pressure on it.

 

[Guyswell]

H.O.T.S.

I can definitely hear it when I'm in a quiet room or lying in bed. Most of the time, I don't pay any attention to it. It doesn't keep me from falling asleep and it doesn't wake me up. Sometimes the sound is a clicking sound and sometimes I can actually feel it thumping. If I'm spooning my wife, the sound bounces off her back loud enough for both of us to hear it. We jokingly refer to my valve as "thumper".

My advice to you is don't worry about it. Expect to hear it but not be bothered by it. As long as it keeps clicking... you're fine.

 

[Gail in Ca]

I'm sorry they are messing with you. My sister has a friend who's husband had to have emergency surgery and avr. He is a pilot for a carrier like fed ex.
She told me her friend said if he chose mechanical , he would not be able to fly anymore!!
I don't know what he chose, but I will try to find out.
Good luck. These experts are morons when it comes to warfarin use. With the great home monitors, your INR will be so stable.

 

[Guyswell]

Tom

Go buy a styptic pencil at Walgreens, CVS or just about any other drug store. They cost a few dollars and have been used for many years to safely stop bleeding from shaving cuts. Your grandfather probably had one in his shaving kit.

 

[tom in MO]

Thanks Guyswell

 

[Protimenow]

The explanation about the INR being a factor related to normal clotting times may make some logical sense -- but in actual practice, I haven't found most small cuts to take much longer to close up than they did before I was on warfarin. In some cases, with a good bang or bump, there may be more bruising than otherwise, but aside from the time I dropped a heavy slab of marble on my foot (which probably would have bruised whether or not I was on warfarin), I've had few bothersome events in the 21 years that I've been taking warfarin. (One dental extraction seemed to take quite a while to close, but most small cuts were non-events for me)

It DOES sound kind of like the department MD doesn't know a lot about warfarin, and that liability just MIGHT be an issue.

 

[Warfarinking]

It is real simple, if your INR is 2, your blood will clot in twice the time as if you had no warfarin, INR is 3, your blood will clot in three times the time. If your INR is 2.5, you will get ~2.5 times the amount of blood before clotting.

is it possible for blood to clot even when in INR range? also, how essential is moving/exercising when on coumadin? I hear crossing legs for too long/not moving legs can cause clotting. Should I be moving my legs a lot to prevent anything?

 

[ski girl]

People on warfarin are the least likely to have random blood clots! Moving and exercising is important for EVERYONE. And yes your blood will clot no matter what your INR is - as explained very nicely by Tom in MO above.

 

[chaconne]

I've been on Warfarin for 1.3 years now, during which I've had to have stitches for 2 big cuts. One was for accidentally stumbling into the edge of a paver with bare feed. My big toe got a deep, 3/4" wide gash. Surprisingly, it stopped bleeding in about 10 minutes. The other cut was accidentally slicing the knuckle of my pinky while trying to stab and remove the seed of an avocado (knuckle head!). This one wasn't as deep and was less that 1/2" wide, but it bled for over an hour.

The bottom line is, often when I expect a cut to bleed for a longer time or get a visible bruise, I won't. On the other hand, I do get some big mystery bruises, and sometime the smallest cuts bleed for a while. Overall, the bleed time has not gotten longer for me, but I do notice more unexpected bruises.