Question for Al Lodwick

[Sierra Bob]

Assume one stops taking warfin for a pending surgery. Also assume while not on warfin, plaque builds up on the mechanical heart valve but doesn't slough off. When one begins retaking warfin, does the plaque "dissolve" into the blood or remain on the valve so if one is off warfin in the future there will be even more plaque and the possibility of it sloughing off?

 

[bvdr]

Good question Bob. I've often thought about the same thing and/or slight variations of it.

 

[Guest]

Plaque is a cholesterol-based build up. Warfarin has no effect on this. There is really no plaque-buster drug on the market yet.

What you are describing is probably a blood clot building on the valve. Warfarin does not dissolve clots, it prevents their formation or growing after they form.

This is why I feel that it is so important that you not stop warfarin for something so trivial as teeth cleaning. I think that you have a better chance of living with bad teeth than a bad valve.

This is also why I feel so strongly that you should be on Lovenox every time your warfarin is stopped.

It is you who has to live with the damage, not the person who wrongly estimated the risk.

 

[bvdr]

That is what I was thinking of Al.

Another question:

If a clot forms on a mechanical valve is the remedy always surgical? Will it sometimes disintegrate over time?

 

[Guest]

I suspect that little ones form and dissolve all the time. But the big ones would probably wreck the valve or cause a stroke.

 

[Sierra Bob]

Another question for Al

Another question for Al

If the INR is actually measuring the dose of Coumadin taken 2 to 4 days prior, I assume a "shot" of Vitamin K acts rather quickly in lowering the INR (faster coagulation) than taking 2to 4 days. Do you know how quickly? And, how quickly if the Vitamin K is obtained from vegetables? Thanks.

 

[Nancy]

My husband had to have a Vitamin K shot to bring his INR down to get his pacemaker implanted, since it had to be done rather quickly. I believe it worked within a day. And once the surgery was over with it took 15 days to get his INR back up to therapeutic levels so they could discharge him from the hospital.

He also had to have Vitamin K shots to stanch a massive post operative (gallbladder) bleed.

So if you have to have emergency surgery, have no fear, they can get you where they want you very quickly.

 

[Sierra Bob]

Coumadin Question

Coumadin Question

Thanks Nancy. That was the purpose for my question. Also, I am going to have gum surgery next week due to osteoradionecrosis as a result of radiation to my jaw bone and teeth because of the "Head & Neck" cancer I had in '99 (as well as the AVR and quad by-pass. The surgeon wants my INR under 2.5, whereas my cardiologist wants it around 3.5. Since I self test, I was wondering if I could eat a lot of greens the day before surgery to bring it down. Bob

 

[Nancy]

Not sure if you could compare eating greens to bring your INR down to getting a controlled and measured shot from a doctor. Better check on that one with the gurus.

 

[ticktock]

Plaque from previous comment

Plaque from previous comment

Allodwick wrote:
I suspect that little ones form and dissolve all the time. But the big ones would probably wreck the valve or cause a stroke.

Al and all...... I formed a "panus" or plaque under a Bjork Shiley aortic valve, they described to me as "large"... It caused the valve to malfunction, ie; it could not open properly causing outflow obstruction. The valve indeed "failed" as mentioned by Al.

Dr Cooley in Houston did a reroute, not wanting to disturb the remaining valve/plaque and not wanting to do a 4th sternal surgery. Interesting, I had not seen this subject mentioned before. Who knows what caused mine to form, I had it for 21 years before the problem was noted.