Martefarin (warfarin) and sildenafil citrate

[kobaha21]

Hello..
Not been here one or two months. I am still alive.

Finally I done my TEE exam. My cardio surgeon team dont want
to talk with me without TEE exam.
I done it now. I an candidate for valve raplacment.

Finally,now i now that I have biscupid aortic valve type 1 with RAPHE between two cuspis.
AVA 08 cm2. In echo AVA was 0,5cm ?

I get consilium cardiosurgeons letter that I must change the valve and I have meeting for
termin in two weeks. I doing my dental works and some CT scans..

I have two questions:

1. Do anyone knows what is RAPHE in bisupid valve ?

and second one.

2. After my surgery when I will be on warfarin, does anybody know something about
sildenafil citrate and warfarin?
I have some problems with erection and i take 50g of sildenafil citrate before sex.
My wife knows that and I dont have ANY ANY problems and side effects of sildenafil.
Works great ! I do that for years. Never have serious problems.

I read few times that sildenafil and warfarin is ok together on some forums
(not at same time of course).
Did any one try take sildenafil (i talk about 50g half tablet) during warfarin with mechanical
valve.

I know that is early to ask that(not yet do a surgery) but I must collect some information.
I know to search on googl. I need real people who try that and know something about it.
I don't have pulmonary hypertension and dont have any health problems except biscupid valve.


Tnx,

 

[pellicle]

Hi

1. Do anyone knows what is RAPHE in bisupid valve ?

Google dictionary:

Anatomy•Biology​

a groove, ridge, or seam in an organ or tissue, typically marking the line where two halves fused in the embryo.​

Note how it appears here:

as a kid I used to explain to people that my problem with my aortic valve (many didn't even know what that meant either) was that a healthy one is split into three flaps in the manner of a Mercedes Benz emblem, but due to a problem in the embryo development (certainly by high school I'd studied the basics of embryology in biology) the cusp never split. (I was diagnosed with a murmur about 5yo and had my first surgery at about 10 yo in about 1974)

So the line where it should have split, it didn't

2. After my surgery when I will be on warfarin, does anybody know something about sildenafil citrate and warfarin?

Here's the thing: you have to understand what words mean in a context. When you say "a flat tyre" it means its not got pressure in it, its not "flat"

With Warfarin management you are dealing with professional people predominately writing to other professional people and just habitually mentioning (and probably have actually zero experience) the possibility that something may happen.

This is exacerbated in the literature because of the bone lazy (and imo irresponsible) attitude that INR can be managed properly by measuring monthly.

This probably stems from the last century when all INR measurements were derived by vein sample with a needle based blood tests. Sampling often will lead to vein injury and so there was a deference towards sampling less. This injury is well identified in clinical experience.

This is a guess as nothing else seems rational to me.

So when you find

Interactions between your drugs:​

Using warfarin together with sildenafil may cause you to bleed more easily.​

its based in the premise that

• nobody is monitoring you,
• those that are are doing it infrequently
• they have something less than no idea on how to properly titrate (medical word for adjust properly) your dose
• are not well qualified or educated
• don't actually have any "skin in the game"

The reality is that all drugs follow the same rules: dose amount and frequency of that dose. Taking something once almost never harms INR, taking it regularly (hourly, daily ...) may.

Amount is the second key, for even water taken in a large amount is harmful.

My advocacy is always simply this:

1. test
2. learn
3. know yourself

Best Wishes

 

[Chuck C]

a healthy one is split into three flaps in the manner of a Mercedes Benz emblem, but due to a problem in the embryo development (certainly by high school I'd studied the basics of embryology in biology) the cusp never split.

You might find this interesting. I recently came across a study which suggests that somewhere between 90 and 95% of BAV individuals might have cusps that fused after birth. See below. The incidence of BAV has been found to be 1% to 2% of the population. This would suggest that about 10 to 20 individuals out of 1,000 would be BAV. This 2019 study of 16,185 newborns found that the number of BAV at birth was less than 1 per 1,000, just 0.09%

"BAV was identified in 14 neonates (0.09%), an incidence of 0.9 in 1,000 live births"

"Conclusion
The incidence of BAV in neonates was much lower than previously reported incidence data. An acquired fusion of the cusps may develop in later life, and eventually may result in increased incidence of functional BAV."

https://academic.oup.com/eurheartj/...9/5594705?redirectedFrom=fulltext&login=false

This is particularly interesting to me, as I have very high Lp(a), which, as you know, is associated strongly with aortic valve calcification and aortic stenosis. I have suspected that there was at least a possibility that my high Lp(a) caused the fusing of two of my aortic cusps. The data from this study makes my belief in this possibility even stronger.

Also, relative to the question about raphe, 38% of those with BAV had BAV with raphe.

"Of the 14 BAV neonates, five had BAV with raphe, whereas nine had BAV without raphe"

 

[pellicle]

Hi

You might find this interesting.

indeed I did

...This 2019 study of 16,185 newborns found that the number of BAV at birth was less than 1 per 1,000, just 0.09%

"BAV was identified in 14 neonates (0.09%), an incidence of 0.9 in 1,000 live births"

I have no idea if I was one of those, but as it was picked up quite young its probable that I am.

"Conclusion
The incidence of BAV in neonates was much lower than previously reported incidence data. An acquired fusion of the cusps may develop in later life, and eventually may result in increased incidence of functional BAV."

very interesting, and I would guess that the only way to discover that was for someone skilled in the morphology of that would be able to really tell the difference

This is particularly interesting to me, as I have very high Lp(a), which, as you know, is associated strongly with aortic valve calcification and aortic stenosis. I have suspected that there was at least a possibility that my high Lp(a) caused the fusing of two of my aortic cusps. The data from this study makes my belief in this possibility even stronger.

that's a pretty reasonable discussion.

"Of the 14 BAV neonates, five had BAV with raphe, whereas nine had BAV without raphe"

fits the data in that study that's for sure.

I don't know if the cost of an Lp(a) test is low, but IMO anyone who has any family history of heart attacks, or valve problems should be tested as soon as they can (and this should be spread around more to doctors and cardiologists (who will no doubt be eager to add this possible prevention to their list).

Very interesting

 

[Chuck C]

I don't know if the cost of an Lp(a) test is low,

It is only $36 US at Quest Diagnostics, and like a good deal of blood work, patients can now order on their own through the lab portal, without a physician order.

https://www.questhealth.com/product...2wgSnfNNONoxSepVXcPuR9lwOJXh160BoCwlAQAvD_BwE

IMO anyone who has any family history of heart attacks, or valve problems should be tested as soon as they can (and this should be spread around more to doctors and cardiologists (who will no doubt be eager to add this possible prevention to their list).

I'm in complete agreement with that and try to advocate this often.

 

[pellicle]

I'm in complete agreement with that and try to advocate this often.

perhaps we can at the very least work on raising awareness of this for members and anonymous readers here who are "searching" such things as "the importance of Lp(a)" in understanding heart health

(*just to increase the hits that Uncle G attributes to things)