Question for Al . . .

[Buzz Lanning]

Al,

I was just wondering if Coumadin was ever administered prior to valve replacement surgery to determine an individual's tolerance to anticoagulation therapy? This could really help simplify the valve selection decision for many people. I ask my cardiologist about this option before surgery, but he said "no'. Anyway, it seems prudent to perform a "test" for a few months before making a permanent Coumadin commitment.

FYI - If I had known Coumadin was NOT going to be a big deal, I wouldn't have fretted the decision to select a mechanical valve. Just a thought . . .
Buzz
P.S. - A "checkout test" shouldn't carry much risk since Coumadin is such a widely prescribed drug.

 

[Guest]

It is an interesting concept. I've never heard of it being done, but I don't know why it wouldn't work.

I think it would help immensely if people could get factual information. Prior to about 1990 warfarin was used but not well understood. They had not yet devised the INR system. We now know that many people back then were intentionally dosed at levels that produced levels equal to INRs above 8. The old bleeding stories are true but they have little to do with they way that warfarin is used today. Then you have advice like, "Don't eat vegetables." and "You can't eat anything green, not even jellybeans." The media doesn't help either, "Man dies from Grapefruit Juice - Warfarin Combination." One person of the millions taking both and they immediately make this conclusion. It sells but it scares too. Even the FDA screws up such as banning Lovenox for anyone with a mechanical heart valve after 5 pregnant women in Africa did not have their dose adjusted as they gained weight. The cranberry juice scare is another. In the original article the title made it clear that the author was asking a question - it ended with a question mark. But that little detail gets left out and suddenly it appears as though anyone taking warfarin who even thinks about drinking grapefruit juice will drop dead.

This is sounding like I think that I am always right and everyone else is wrong, but that is not the message I am trying to convey. It is easier to find fault with someone else...

 

[Buzz Lanning]

Pre-surgery Coumadin trial

Pre-surgery Coumadin trial

Pam,

I'll be curious what your cardiologist says about a pre-surgery coumadin trial. Buzz

 

[Guest]

Pam, does your husband know my son? Matt Lodwick at Red Hawk Ridge in Castle Rock?

 

[Guest]

Head. 38 years old about 6'3" and 240 lbs. Was associate at West Woods in Arvada until he got his "A" card.

 

[Blanche]

The problem here is one of being fully informed before making a medical decision. In 1990, when Albert had his valve replaced, there was just a mention about Coumadin before surgery. It went something like, you will need to take a drug and get tested once a month. Now, 15 years later little has changed. What is needed here is a comprehensive educational program about all of the faucets of anticoatgulation. This needs to be done before surgery. I don't know how this will happen since so many doctors have little conception about anticoagulation, as is evidenced daily here. When I have spoken to Al's cardiologist about this very matter, he has responded by saying that most people are not interested and that he has trouble enough just getting patients to test once a month. Of course, I don't agree with him.

Blanche

 

[Guest]

My experience is that the more people are informed, the more likely they are to take an active part in their own care.

 

[Marty]

Self care

Self care

The message I did not get as a patient was that basically you are on your own and have a lot to learn when you are placed on warfarin for life. So this idea of a preliminary trial is not completely crazy.I would advise you get access to a Coaguchek or other monitor and see if you can learn to use it and keep your INR in therapeutic range. I basically don't trust doctors offices to manage warfarin therapy accurately. I like the idea however of pharmacists handling it. Thats the way Kaiser does it. Al is a good example of how to run an anticoagulation clinic.

 

[Buzz Lanning]

Pre-surgery Coumadin Test

Pre-surgery Coumadin Test

Pam,

Thanks for the info. I'm not surprised your cardiologist was luke warm to the idea. I think there's a liability issue prescribing medication that's not required (yet!).

Buzz

 

[John & Joann]

Joann has been on Coumadin since 1971. She tests monthly at a Coumadin Clinic with the finger prick and machine. We do NOT want to do home testing. This is a personal issue and should not detract from anyone else doing it at home.

She has MAJOR scar tissue from the draws during the 30 years prior to the finger prick. BAD NEWS when an inexperienced tech meets Joann. When we travel, the blood is testing at a remote location by the older draw method. The results are then faxed to the Coumadin Clinic.

Her INR and medication stays fairly constant. If it works, don't break it. We really like the coumadin clinic system. It is a quick in, results, review, and out the door. It normally takes less than 15 minutes. It also provides IMMEDIATE access to the cardiologist if there is a problem. It works.

Happy Clicking and Ticking to everyone.

 

[lance]

I'll second that

I'll second that

The problem here is one of being fully informed before making a medical decision. In 1990, when Albert had his valve replaced, there was just a mention about Coumadin before surgery. It went something like, you will need to take a drug and get tested once a month. Now, 15 years later little has changed. What is needed here is a comprehensive educational program about all of the faucets of anticoatgulation. This needs to be done before surgery. I don't know how this will happen since so many doctors have little conception about anticoagulation, as is evidenced daily here. When I have spoken to Al's cardiologist about this very matter, he has responded by saying that most people are not interested and that he has trouble enough just getting patients to test once a month. Of course, I don't agree with him.

Blanche

Hi Blance,

Truer words were never spoken. Pre-warfarin sessions would be a blessing.

 

[Guest]

Young men are the hardest to convince.