Long term implications of your valve choice when you get other heath issues

[T in YVR]

ok, I think I know the answer to this, but was interested in other perspectives. I am going for OHS/AVR Sept. 24 and have decided to go On-X. But one thing has been nagging at me alot lately: its not the daily management/impact of using Coumadin. I'm ok with that now.

Its the situations you can't really control: i.e. the long term unknowns and other potential health complications that can enter your life as you age - and the question of which valve choice leaves you in a better state to deal with these.

I am healthy (other than AVR!). But my family genetics have a whole host of things like diabetes, Crohn's Disease, Rheumatoid Arthritis, and other auto-immune disorders.

My concern/dilemma is this:

- Go tissue and I will most definitely have OHS at least 1-3 times depending on life expectancy (or maybe TAVI/TAVR if I am high risk or if they do it more routinely). I realize there's a slight chance of having to be on Coumadin with a tissue valve. So, If you get other major health issues (like the ones I listed above, or cancer or kidney/renal/liver issues, or stomach ulcers etc.), there are no complications that your heart problem introduces (from what I'm aware of) because you likely are not on Coumadin. You just have a tissue valve. Of course, if any of these other health issues hit you around the time you need OHS again, then you have to balance what treatment you get and when.

- Go mechanical and you don't have to have OHS (or TAVI/TAVR) again unless you have other heart complications. However.....Coumadin suddenly can come into play and can create complications when it come to treating these other potential major health issues like the ones I mentioned above.

In the end, we make the choices we think are best for our situation and I know you can't live your life thinking "what if, what if" with respect to getting other health issues. But I'm trying to make sure I don't cause myself further grief down the road. We all want to live long healthy lives and get none of these nasty sicknesses, but things break as we age! I'm not interested in OHS again w/tissue, but these other tradeoffs weigh on my mind. Or maybe I am overly worried about Coumadin in these situations?

I could not find this aspect of valve selection discussed much here, so was interested in other perspectives. (especially those of you that have faced other significant health obstacles and are on Coumadin).

Thanks,
Tony

 

[neo]

Long term implications of your valve choice when you get other heath issues

One thing most do not consider with Coumadin is that it inhibits Vitamin K. Research what Vitamin K does in your body, and what potentially may happen over time with a Vitamin K deficiency.

 

[Lex Luther]

T;

I have afib and a 4.9cm ascending aortic aneurysm per my recent MRI and am still in the waiting room. I have been on Coumadin for several years. At 61 I am still an avid cyclist with the blessings of my surgeon, and it has kept me in good shape. Because I have been on the bubble for surgery, I have struggled with the same decision, mech or tissue. Because I required surgery a few years ago, I had to quit taking it several days prior to surgery. I did not have much concern, but I did not have a mech valve. After researching, and this forum has been great, I am leaning towards an Edwards magna, which is a tissue and shows promise of extended use before needing replacement. I have seen older members of my family needing surgery for knees, hips, etc. and am concerned about strokes if I have to be taken off of Coumadin, despite the facts that injections can be given to avoid the clotting issues during that time because the mech adds to the risk. Finally, I am a light sleeper and a clicking valve is also a concern. Just my thoughts now that I know I will probably be in the waiting room another year, and was happy to avoid surgery this year, as I am still relatively symptom free other than my valve/ AI going from mild to moderate. The cycling has be very helpful.

 

[neo]

Long term implications of your valve choice when you get other heath issues

Edwards Magna Ease is great. St Jude Trifecta is also great. Research both and find out which one the main institutions are using now.

 

[pellicle]

One thing most do not consider with Coumadin is that it inhibits Vitamin K. Research what Vitamin K does in your body, and what potentially may happen over time with a Vitamin K deficiency.

No, it inhibits recycling of vitamin K. There are many papers discussing the carboxilation issues and how adequate vitamin k AND warfarin are compatible. Ask GymGuy for more details

What did your research reveal?

 

[neo]

Long term implications of your valve choice when you get other heath issues

What is the difference in inhibiting vs recycling of vitamin k? Do people who are on Coumadin long term ever have a Vitamin K deficiency?

 

[dick0236]

One thing most do not consider with Coumadin is that it inhibits Vitamin K. Research what Vitamin K does in your body, and what potentially may happen over time with a Vitamin K deficiency.

Can you be more specific about "what potentially may happen". I did a quick search on line and the problems I found have to do with blood clotting, bruising, etc......and we know of all those 'cause that's why we take it. The web also mentioned "bone fractures" but I never had a fracture in my 30 years before warfarin....or in my 46 years while on warfarin. My own personal long term experience is:
+I still have ALL of my hair.
+I look to be age 60, not almost 78. Maybe warfarin works like "botox"...another poison.
+I have most of my mental abilities.
+I can hit a golf ball farther than most of the seniors I play with, and I'm one of the oldest.
+I eat all of the Vit K I want several times a week....like we say "don't diet the dose...dose the diet".
+ My sex life went to hell...but that is mostly due to age and blood pressure pills, not warfarin use.

There used to be an Anesthesiologist on this board whose experience with Warfarin was similar to mine....and we joked that Warfarin might have a few positive long range benefits.

 

[neo]

Long term implications of your valve choice when you get other heath issues

Dick, that is really funny, but also really great that you can have an absolutely normal life after having a mechanical valve for so many years. I have read recently about the complicated relationship between Vitamin K, Vitamin D, Magnesium, and Calcium. It seems that Vitamin K plays a role in telling the body where to put your calcium (bones vs tissues). They call the relationship a "paradox" as it is not fully understood. There is a book on the matter, but more importantly a YouTube interview which explains the paradox. For you to be completely healthy taking Coumadin for all these years, it must not be extremely significant or anything to be worried about. Thanks for that insight!

 

[pellicle]

What is the difference in inhibiting vs recycling of vitamin k?

The body has systems for using and re-using things (unlike society where we use it since and toss it). this means that you need to ingest less if there happens to be less in the environment.

Inhibiting the action would mean that what it does is blocked. Like if I hid your car keys when you wanted to go out.

From wikipedia:
Vitamin K antagonists (VKA) are a group of drugs that reduce blood clotting by inhibiting vitamin K epoxide reductase and thus the recycling of vitamin K epoxide back to the active reduced form of vitamin K. These drugs reduce the action of vitamin K by depleting the active form of the vitamin. The term "vitamin K antagonist" is a misnomer, as the drugs don't directly antagonise the action of vitamin K in the pharmacological sense, but rather the recycling of vitamin K

Do people who are on Coumadin long term ever have a Vitamin K deficiency?

No more than anyone who does not eat a healthy diet. Have you done any reading? Like starting with the stickies on this forum?
You began with an assertion

Research what Vitamin K does in your body, and what potentially may happen over time with a Vitamin K deficiency.

Which suggested you were in a position of knowledge about the effects.

 

[pellicle]

Neo

Quite some review of the medical literature has been started by thegymguy, this post of his is a good start

http://www.valvereplacement.org/for...d-Anticoagulation-Control&p=519438#post519438

But this one is a good starter

http://www.lef.org/magazine/mag2007/jun2007_report_vitamink_01.htm

Several recent studies, both in the US and Britain, have found that supplementing with low-dose vitamin K (50-150 mcg/day) may help stabilize the daily fluctuations in INR that occur due to varying dietary intakes of vitamin K.5 If necessary, the physician can slightly increase the patient’s warfarin dose to counteract vitamin K’s tendency to increase blood clotting.

I noted in my own readings uncertainty about the issues of Vit K and bone calcium. A good review of this was in Nutritional Reviews Vol 66 (which is 2008 and the underline is mine)

Update on the role of vitamin K in skeletal health
A protective role for vitamin Kin bone health has been suggested based on its role asan enzymatic cofactor. In observational studies, vitamin K insufficiency is generally associated with lower bone mass and increased hip fracture risk. However, these findings are not supported in randomized controlled trials (RCT) of phylloquinone(vitamin K[sub]1[/sub]) supplementation and bone loss at the hip in the elderly. This suggests that increased vegetable and legume intakes may simultaneously improve measures of vitamin K status and skeletal health, even though the mechanisms underlying these improvements may be independent of each other. Menaquinone-4(vitamin K[sub]2[/sub]), when given at pharmacological doses, appears to protect against fracture risk and bone loss at the spine. However, there are emerging data that suggest the efficacy of vitamin K supplementation on bone loss is inconclusive.

also, it is emerging (because we don't know everything about this area of biochemistry) that other factors such as exersize have a significant effect on bone strength. It is quite likely that the sedentary nature (often advised by Physicians without a clue) is as significant a factor on bone density loss as is any other thing. You will find quite a many active people here on Warfarin. I expect that these people will have the best bone outcomes and be above the median bone strength in the population when they are in their 70's

Old adage "don't use it, you loose it"


Hope that helps

 

[neo]

Long term implications of your valve choice when you get other heath issues

Thanks Pellicle. I appreciate your research. I think it is also great to hear from people like Dick who clearly are fine taking Coumadin after so many years.

 

[pellicle]

Hi

I have struggled with this ... but after a beer have decided to 'comment'

+ My sex life went to hell...but that is mostly due to age and blood pressure pills, not warfarin use.

most people I know who are married for some time blame other things for this ... like their partner ;-)

 

[dick0236]

Hi

I have struggled with this ... but after a beer have decided to 'comment'


most people I know who are married for some time blame other things for this ... like their partner ;-)

Uuuhhhh......ain't no way I'm gonna comment.....my wife of 56+ years would kill me.......but on a serious note????, I really think it is the BP pills.

 

[tom in MO]

If it's the BP pills, low dose Cialis is your friend. It's the best recreational drug I've had since 1978 But it's too expensive for me. You can get a free 30day trial from any urologist.

Per T's concerns, of your listed problems, my experience is with arthritis. You cannot take long term doses of some of the best medications on coumadin. Not because of any direct problem, just those drugs can cause stomach bleeding, which is worse with coumadin. However, that did not stop me from getting a mechanical valve.

 

[T in YVR]

Thanks Tom - yeah, its those kinds of things that bother me. You just never know what the future holds....the stomach ulcer/internal bleeding side is nasty. So many drugs can cause this. I suppose those which are enteric coated may be better if available (but I imagine many powerful drugs/top medications don't fall in that category - just the basic pain meds). My wife kids me because I am always banging my head on something because I move too quickly when doing things. That will have to change...

 

[tom in MO]

You really do not need to wory about cuts and scrapes. The way the warfarin works is pretty simple. My INR is in the 2 - 2.5 range, that means it takes a cut 2 to 2.5 times longer to clot. It still clots, just not as quick.

A few months ago I got bit in the hand by my blind, demented, brain-tumored dog. I got numerous lacerations, puncture wounds and a subsequent infection that swelled up to my mid forearm. The warfarin was never a problem, it just takes longer to stop bleeding. I make sure I always use non-stick guaze and bandaids so when I changed the bandages it doesn't start bleeding again.

 

[Stopper]

From what I understand, warfarin inhibits vitamin K only in the coagulation cascade at factor 2, 7, 9, and 10. Warfarin does not interfere with the bodies utilization of vitamin K anywhere else. So the best thing to do is be consistent with your vitamin K intake. That way the coag clinic can find the right dosing regimen for you. There are some great apps out there to help in understanding the vitamin K content in foods.

 

[pellicle]

Hi

pardon me, but off topic here ...

...I got bit in the hand by my blind, demented, brain-tumored dog.

but was this a metaphor or an accurate description?

 

[tom in MO]

Oh it is accurate.

He's had a brain tumor for almost 3 years which makes him blind and clinically demented...per vet. Three years ago the vet said he had 2 months or 2 years to live.

I came home and broke the old adage "let sleeping dogs lie." He growled at me, just in the previous 9 years he never bit. Now he growls and I leave him alone. He's a rescue dog from the streets, not a home.

Besides his sight, the brain tumor has cut of the pain of his arthritic hips, so he still has trouble getting up or down, just no pain. His eyes are really freaky, totally dilated because they still see, it's just the signal is getting to his brain. It's amazing to see how he copes, kind of funny too when he barks at the door, but is off 3 feet or runs into an open cabinet door when he hears food hit the floor.

 

[Lily]

Hi Tony -

Your question is valid and important.

At best, individual experiences of various members may only be isolated perceptions and recollections.

Perhaps you could present your question to some respected surgeons via email?

Also, I just read some recent stats about transcatheter valves and understood they're still not an option for those with native bicuspid valves though you would probably want to ask your surgeon about that too.

Best wishes