caterb85 said:
after being diagnosed with a acending arota anuerysm, my husband had his valve replaced with a st jude aortic valve and root . He then had trouble with his electrical system in his heart working properly, so they had to put a pacemaker in 4 days later. The next day he developed a-fib and had to start meds for that, 4 weeks post op and taking warfin and adarodone for a-fib. My question is what are the percentages for developing blood clots or bleeding trouble?
Welcome to our World! MANY patients live with the same issues your husband has incurred. The KEY to successful management is Education and Training.
The Risk of Stroke from clotting rises when INR is Below 2.0
The Risk of Bleeding rises when INR is Above 5.0
(Note that MANY of our members have reported NO bleeding at 5.0 and some even at 8.0 for short periods)
The Biggest Risk of Stroke with Mechanical Valves comes when it is necessary to come OFF Coumadin for invasive procedures. Risks can be minimized by the use of Short Acting Anti-Coagulants before and after the procedure. These include Lovenox Injections based on Body Weight and a Heparin Drip which is almost always administered in a Hospital setting.
Old School thinking had people come OFF Coumadin for many minor procedures. Modern thinking has re-evaluated the Bleeding Risk vs. Stroke Risk and recommendations for Dental Procedures and Minor Surgery (Foot Care and even cysts) are to perform the surgery while anti-coagulated, taking extra care to control bleeding locally). One of our Favorite Sayings is:
"It is easier to replace Blood Cells than to replace Brain Cells!"
You can learn all you need to know from AL Lodwick's informative website
www.warfarinfo.com AL is a Certified Anticoagulation Care Provider, Author, and Consultant who runs his own Coumadin Clinic in Pueblo, CO.
The BEST control of INR is frequent SELF Monitoring with a Home Test Instrument. Dedicated Coumadin Clinics with trained Nurses who monitor 'as needed' (typically monthly but more often if INR is changing for any reason) are a close second. Quality of Coumadin Care varies WIDELY with individual physician / nurse providers, many of whom seem to be operating under outdated guidelines or have limited experience due to treating only a small number of patients.
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Regarding A-Fib
Atrial Fibrilation is a fairly common Post Surgery event that often resolves itself after a few months (sometimes weeks).
Some Doctors like to prescribe Amiodarone 'because it works'. Amiodarone is the SLEDGE HAMMER of Anti-arrhythmics with a Laundry List of ADVERSE Side Effects (especially affecting the Eyes and Lungs) and requires CLOSE MONITORING to prevent permanent damage. (See the Package Information Sheet or do a SEARCH on VR.com to find considerable discussion of this medication).
Also note that Amiodarone has a Very LONG Half Life which means that it takes MANY MONTHS to fully leave the body after it is discontinued. On the positive side, it works to stop A-Fib and seems to be safe when used appropriately (i.e. controlled doses for a limited period of time.) Problems have occurred when patients were NOT told to discontinue it after it was no longer needed or signs of damage were not seen or heeded.
When I developed (mild) A-Fib, my Cardiologist put me on SOTALOL (the Generic Form of BetaPace) which has worked quite well at a very low dose. I was told that Sotalol is a Beta Blocker that "targets" A-Fib. It is usually recommended that patients be hospitalized for a few days when first starting this medications 'just in case' dangerous arrhythmias are triggered before the body fully adjusts to the medication. Not all Doctors do this.
Bottom Line: With proper monitoring it is possible to live a LONG and HEALTHY Life with these conditions.
'AL Capshaw'
