Latest Summary of Valve Choices

[Guest]

I agree with this article except for its statement of lifelong warfarin. I doubt that anyone will be taking warfarin within 10 years.

Current status of the mechanical valve and bioprosthesis in Japan.Tokunaga S, Tominaga R.
The Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, [email protected].
J Artif Organs. 2008;11(2):53-9. Epub 2008 Jul 6.

The American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease were revised in 2006. These guidelines are introduced in this review, and the current status of the mechanical valve, bioprosthesis, and treatment of valvular heart disease are described based on the new guidelines as compared with the guidelines of 1998. The trend in valve selection in aortic valve replacement in the United States has been toward bioprosthesis, away from the mechanical valve. The reasons are: 1) current bioprostheses appear to have lower rates of structural valve deterioration, 2) the risks of reoperation have continued to decrease, 3) patients undergoing AVR today represent an older population than those in studies in randomized trials, 4) young patients undergoing AVR are often reluctant to accept warfarin therapy, 5) some large comparative trials have shown apparent survival benefit for patients receiving bioprostheses. In Japan, the use of tissue valves has been increasing and may continue to increase owing to the nation's aging population and to the reasons mentioned above. However, more patients received mechanical valves than bioprostheses for mitral valve replacement both in the United States and in Japan. The number of mitral valve repair cases has increased more than that of valve replacement. In selection of valve prosthesis for valve surgery, it is important that patients should decide by themselves based on mutual respect and trust between patient and doctor, with thorough discussion of the possibility of redo surgery and its risks, life-long warfarin intake, quality of life, and the patient's lifestyle and outlook on life.

 

[Lynlw]

here is the full guidelines, if it isn't already here http://content.onlinejacc.org/cgi/c...3bc18dda4872267de310ee53&keytype2=tf_ipsecsha
it is pretty long

 

[Guest]

There is a whole alphabet soup of drugs being tested to replace warfarin. Most likely more than one of them is going to "make it". The liver toxicity is most worrisome when the drug is first introduced. After 10 years we will have a pretty good idea of whin one(s) is/are safe. There are many people who will want to be the first to take the new drug and these will be the people who will be studied the most.

 

[Ross]

I don't think I'll choose to be one of the first. If somebody else wants to be first, that's fine with me.

Me neither, I'll stick with Coumadin until it's proven. Got enough problems and need my liver.

 

[marie]

I was at the cardio's office on Thursday and noticed a typed sheet of paper over the desk. I walked over and read it but didn't retain much of it. They were looking for coumadin users that were non compliant. Examples were not taking as recommended, INR not stable, alchol use. There were several others listed. I don't think it was there for the patients to read but to remind the doctors however that's only my assumption.

On the very bottom there were two meds listed and I don't remember the names of those either. Wish I had paid more attention now.

I'm assuming it must be some type of trial.

Earline

 

[Duff Man]

wait a minute -- you can't drink on coumadin?

 

[Ross]

wait a minute -- you can't drink on coumadin?

Son you need to check the anticoag forum. Yes you can drink, but it's not encouraged. Reason being if your prone to ulcers, alcohol is likely to irritate the lining and cause a GI bleed that could be dangerous if your on Coumadin. There are many things you can do that I'm sure your being told that you can't do on Coumadin. Myths are abundant.

A couple beers, wine or mixed drink occasionally, in moderation, is not a big deal.

 

[Mark Wagner]

I have been on Coumadin since January of 2000. I find that if I am drinking a little more than moderation; such as vacations, and or special occasions; I monitor my INR more frequently, and most certainly within one week of the indulgence. I have learned the hard way, that farting around and neglecting your INR can be a recipe for disaster. A hospital stay of 2 days in intensive care, and 3 days in general care, with blood coming out of almost every orifice in my body, with shots of vitamin K to boot, taught me the hard way. Something to think about.