Vanderbilt University and 'Blood Thinner' Dosing......

[Jkm7]

It is highly likely percutaneous may be a viable option should I live long enough to require another valve replacement. I well could fit into the 'perfect profile' for such a procedure. Percutaneous is not some far off over the rainbow concept. It is being done today.

But I wasn't 46 when I had my valve implanted. I think most of us know someone that young often will not get long life from a tissue valve. Older patients can realistically expect for their tissue valve to last longer.
We all make choices and live with those choices.

And that, of course, is my whole point. Give those who come here to learn before they make their choice the opportunity for as truthful info as possible. Don't try to steam roll or bully them for one choice or the other. No one but them can make that choice and no one should try hard to do so IMO

 

[drivetopless]

I was one of those people who was started on 5 mg per day in hospital along with Heparin IV and i ended up staying in hospital for a total of 16 days while the docs stabilized my INR....I ended up leaving on a dose of alternating 3mg and 2mg which surprised them that I was on such a low dose. The good part of it was that since they had gotten me solidly stable, I stayed stable, no waffling around, no roller coaster ride for me.

I might be like you, Bina.
After being on 5mg per day for the last two weeks since my surgery and holding for 3 days within that time, my INR is waffling between 1.8 and 4.6. It's all over the place and the INR tech doesn't understand why I am so volatile on such a slow dose (35mg/week). She says that people my age (ie. young people (I"m almost 47)in her opinion) usually require dosed in the 70-90mg/week range.

 

[Bina]

I might be like you, Bina.
After being on 5mg per day for the last two weeks since my surgery and holding for 3 days within that time, my INR is waffling between 1.8 and 4.6. It's all over the place and the INR tech doesn't understand why I am so volatile on such a slow dose (35mg/week). She says that people my age (ie. young people (I"m almost 47)in her opinion) usually require dosed in the 70-90mg/week range.

I was the same age as you when I started the Coumadin thing.
I hope they didn't hold any doses for the inr of 4.6

 

[ALCapshaw2]

I find it interesting that so many of the Negative Posts about Living with Anti-Coagulation come from members who DO NOT TAKE COUMADIN.
Isn't that ALSO a "disservice" to new members?

Most of our members who take Coumadin / Warfarin have learned how to manage it properly and live quite well, some even engaged in highly (non-contact) athletic endeavors. The KEY is proper management. Dick0236 has been taking Coumadin for 43 Years with only ONE 'event' (a non-fatal stroke) which was a result of NOT taking his Coumadin with him on a Hunting Trip. He has NOT reported any bleeding events.

From what I hear, the Genetic Testing is rather expensive.
A Good Manager should be able to stabilize a newcomer to anticoagulation in several weeks.

 

[Protimenow]

I don't think I recommended a mechanical valve over a tissue valve - or vice versa. I mentioned that tissue valves seem to be getting better and lasting longer and that there was work being done with non-invasive valve repair (the percutaneous that was mentioned). I don't think I stated anything that hasn't been borne out with tons of clinical experience.

When I had my surgery, the choice was tissue (with a high probability that I would need another OHS to replace it during my lifetime) or a mechanical (which was most likely to last me the rest of my life). If I had a choice to make today, I'd probably be looking at a different situation because tissue HAS improved and because there's a strong possibility that some weaknesses in tissue valves will be repairable without cracking my sternum.

As for my years on warfarin - I've had to reduce my dosage a few times for dental extractions and some minor procedures - the only time I had terrible swelling is when I dropped an 80 pound (or so) piece of marble on my foot. Beyond that, I haven't had major bruising or other bleeding events that were remarkable enough to spring to mind.

I hope that whatever I've written isn't seen as advice about valve choice. It's just that I've seen a lot of negatives about warfarin (from people with no valves at all or with tissue valves) that really overstate the negatives.

A fair, balanced assessment of the problems related to mechanicals (noise, warfarin, etc.) versus the tissues (potential need for repair or replacement eventually) should be made when the choice is at hand. (One more thing - there are many drug development programs that may come up with a replacement for warfarin. The problem with testing and adjusting doses may go away, from what I've heard, within a decade or less. If anticoagulation was no longer a troublesome issue, the mechanical may begin looking even better for some people)

 

[normofthenorth]

Interesting information Norm.

When patients are required to go OFF Coumadin / Warfarin, they are often "Bridged" with Low Molecular Weight Heparin (a.k.a. Lovenox which has a very short Half-Life) while the Coumadin / Warfarin effects 'drop off' before the procedure and then build up after the procedure.

Bridging with Lovenox Injections or a Heparin-IV drip After OHS while beginning Coumadin / Warfarin 'should' prevent (or greatly reduce) the risk of clotting while the C/W medication metabolizes and stabilizes.

'AL Capshaw'

Thanks, Al, and I agree. Since I've posted, I've thought of another real-life situation where this "paradoxical" effect of W/C could be important. That's when an ACT person stops the W/C for a while, like for surgery. That's what you call "bridging", often with Lovenox. But most bridges only go from one shoreline to the other -- i.e., it seems logical to stop the Lovenox injections as soon as the patient's INR is back in the therapeutic ("target") range -- or maybe even still a bit below it.

This chemistry suggests that it's probably worthwhile to continue the injections for ~48 hours AFTER your INR is back in range. I wonder how many people are skipping that step now. . .

 

[Bina]

Thanks, Al, and I agree. Since I've posted, I've thought of another real-life situation where this "paradoxical" effect of W/C could be important. That's when an ACT person stops the W/C for a while, like for surgery. That's what you call "bridging", often with Lovenox. But most bridges only go from one shoreline to the other -- i.e., it seems logical to stop the Lovenox injections as soon as the patient's INR is back in the therapeutic ("target") range -- or maybe even still a bit below it.

This chemistry suggests that it's probably worthwhile to continue the injections for ~48 hours AFTER your INR is back in range. I wonder how many people are skipping that step now. . .[/QUOTE]

Norm, this is something NOT to mess with. The protocol is very specific:
After a procedure is completed Lovenox is administered and Coumadin is re-started. When the INR is back in a safe range
and is stable, the Lovenox shots are immediately stopped as they are very short acting. There is no need to take both
together at that point as the bleeding risk would be tremendous.
Our previous Moderator, Ross, had a horrible bleeding issue due to Lovenox after all his teeth were surgically removed.