Who has bio valve and takes coumadin?

[Kate]

It is frequently mentioned in discussing valve options that many people with a biological valve end up on Coumadin anyway because of a-fib. This is obviously scary for me (talk about the worst of both worlds!) and I was wondering how often this happens. I don't know how to set up one of those polls but I just thought I'd throw out the question - how many of the biological valvers on VR.com also take Coumadin? Thanks, Kate

 

[Mary]

Not me; knock on wood!

 

[bvdr]

This article is a pretty good one on atrial fib in general. It states that in patients who have valvular heart surgery the incidence is well over 30% and as high as in the mid sixties for those who are elderly. I think that section is on page two.

I was in atrial fib before surgery. It was in fact what introduced me to the world of being a heart patient. Skies have a few more clouds here but I have found the people living here to be wonderful.

http://www.ajmc.com/files/articlefiles/A67_2004aprlAbusaada50_7.pdf

 

[Kate]

Betty,
Thanks so much for taking the time to post this article. I found it very comforting. If I'm reading it right, it seems to be saying that most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin. It also seems to suggest that for first-time a-fibbers, the condition corrects itself without any medical intervention at all 72% of the time. This seems much more optimistic than I'd feared!

Any bio valvers out there on Coumadin? I'm still curious! (You know what they say, curiousity killed the Kate ) Kate

 

[cocoalab]

Andrew has a bio and an ICD. He just takes aspirin. He had been on Coumadin for 9 years. It wasn't horrible by any means but it is nice to not have to worry about dosages and tests for that at least.

 

[Lynlw]

Justin has bio and it was his 4th OHS and he takes nothing either.
Actually today is a pretty Happy day, he has played baseball since he was 4 (he's 17) and had to miss last season because of his surgery and today was his first day back. he caught for 6 innings, so I think his legs maybe a little sore tomorrow, Lyn

 

[cocoalab]

Lyn that's great. But playing baseball in January in New Jersey sounds funny!

 

[Lynlw]

I guess I should have mentioned it was indoors lol
Wendy I am so gald andrew is doing so well. I'm thinking 2006 will be a good year, Lyn

 

[Karlynn]

At 54 my brother-in-law had a stroke due to the fact that he was in continual a-fib and didn't know it. He has no other health problems. Fortunately the stroke was mild and he is now on Coumadin.

I started a brief thread a few days ago wondering what celebrities take Coumadin. I had heard that Ellen Degeneras and John Mayer both suffer from chronic bouts of a-fib and was wondering if they were on ACT for it. So apparently a-fib is not unheard of in younger people.

I was also wondering if anyone here had received a tissue valve and ended up on Coumadin because of a-fib. At the moment, I don't recall anyone.

 

[catwoman]

A friend received a bovine valve, mitral position, in December 2002 and is still on warfarin for a-fib.

 

[Kate]

Thanks everyone for taking the time to respond! Justin and Andrew both sound like real troopers. I can't imagine going through one straight-forward OHS at their ages, let alone what they've been through!

The sense that I'm getting overall is that it must not be terribly common for people with bio valves to need Coumadin. Admittedly, this isn't a very scientific test, but so far we've only found one (Marsha's friend) as I'm assuming Andrew was on Coumadin when he had his St. Jude's but went off when he got his new bio valve last year. It would be interesting to hear from Al about how many people with biological valves he treats at his clinic. Kate

 

[Lynlw]

Thank Kate, this is an interesting question, I think I'll ask my CHD boards and see what I found out there too. Oh Justin caught six innings yesterday for the first time in a year and 1/2 (he had his conduit replced and got a pulm valve in May) I thought he would be sore today, but he is off snowboarding, He is so happy doing everything he wasn't allowed ot do last year, because of his heart. Lyn www.caringbridge.org/nj/justinw

 

[Marge]

<<[The article said] most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin.>>

I'm not sure that you should rely on this.
I have a "biological" valve in the sense that I still have my original valve -- which as far as I know is a biological one! LOL! I had a successful valve repair in early 2004. I am 67; I don't have diabetes; I did have high blood pressure but it is now well controlled (usually I am well under 120).
And yet, I am on coumadin.
About midway through 2005 I was diagnosed with atrial flutter. My cardiologist advised me to start taking coumadin to reduce the risk of stroke. I thought very hard about the pros and cons. My cardio was not adamant about coumadin; he left it up to me whether I decided to go on coumadin or just took aspirin. However, from what he told me, & what I read, the risk of stroke was sufficiently lower with coumadin than with aspirin that I decided to follow his advice.
One footnote: My cardio said that when he was in med school atrial flutter was not treated as aggressively as atrial fibrillation, but that nowadays it is thought best to treat both with coumadin.
Really, it has not been particularly hard for me to deal with being on coumadin. I was quite reluctant to go on it; but have found it is not so bad, even though sometimes difficult for the techs to find a vein; I'm a "difficult" draw. My INR is very stable so I usually only test once every five weeks or so.

 

[Guest]

I see several people in my clinic who have bio valves, atrial fib, are under 75 and take warfarin. Doctors seem to be prescribing it to younger people.

I don't want to cause undue alarm because I only see people who have the combination of problems, not the ones who are successes. I know of one woman who was put on it at age 31.

 

[Wise]

<<[The article said] most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin.>>

I'm 47 and would be on coumadin if my ablation hadn't been successful. May still have to go on it since ablations aren't always a permanent fix.

 

[Guest]

Thanks Wise for your perspective. In my clinic I only see the people for whom it didn't work. I hesitate to put that on this site because it puts too much of a negative tone on things. People do need to know that nothing is 100%.

 

[Kate]

Thanks Al, Marge and all - It's clear that there is no sure way to avoid Coumadin (even for people who haven't had a valve replaced.) However, it's still comforting to know that most people who choose biological valves don't take it. Not because it's so awful - I know most of the people on this site lead normal, active lives on Coumadin -simply because we've made some sacrifices to avoid it, and it would seem like such a bad deal to end up with both multiple surgeries and Coumadin. Best, Kate

 

[Ross]

Thanks Wise for your perspective. In my clinic I only see the people for whom it didn't work. I hesitate to put that on this site because it puts too much of a negative tone on things. People do need to know that nothing is 100%.

negative tone or not, it's needed information and I don't believe in not being truthful about the possible scenarios that may play out.

 

[RCB]

Problem with article

Problem with article

Is that is does not address directly the problem of of several surgeries and how increases in age affects the likelyhood of AF or the fact that drug therapies tend to be less effctive over time. With the trend to younger and younger people getting tissue value and needing more surgeries, we may not see the results of their decisions for years. I went 20 years before I had my first attack and was in and out of AF for 15 while on drug therapy. Finally, even drug therapy couldn't help. Many EP out there, clearly don't know what their doing and the gold standard for AF cure is over 19 years old(and that procedure envolves open heart surgery). Af is a BIG problem, that will be getting bigger as people age and have more surgeries. This research seemed to avoid this coming menace.
You also have to remember that practically all of the oldest(in terms of the time of valve implants) are mechs, because the early tissue value came later and many fell apart in short order. That is going to affect any survey.

This article is a pretty good one on atrial fib in general. It states that in patients who have valvular heart surgery the incidence is well over 30% and as high as in the mid sixties for those who are elderly. I think that section is on page two.

I was in atrial fib before surgery. It was in fact what introduced me to the world of being a heart patient. Skies have a few more clouds here but I have found the people living here to be wonderful.

http://www.ajmc.com/files/articlefiles/A67_2004aprlAbusaada50_7.pdf

 

[Karlynn]

I think the main point is making sure that people are informed. People choose tissue valves in order to avoid Coumadin. Aside from the arguments of repeat surgeries, scar tissue, etc etc (all the points we provide), people need to understand that going tissue does not guarantee a life without Coumadin. Just as they also need to know that going mechanical does not guarantee no additional valve surgeries.

To get into statistics can be pointless if you end up drawing the short straw. And let's face it - all of us here have drawn the short straw because we all have heart valve trouble - when the statistics show that most people do not.

When my MVP was diagnosed, I was told that as many as 10% of people have it, but that only a small percentage of those people have problems to the point of needing surgery -and if they do, they are most likely in their old age. I went on blissfully ignorant, so sure I was not going to be part of that small percent, then BAM - smackdab into a giant brick wall of valve trouble ending in replacement at the age of 32. This was a BIG lesson for me that I can not count on falling on the positive side of a statistical equation. It's not always someone else that falls on the negative statistical side.

So people make a choice for tissue, but make that choice knowing that you still may end up on Coumadin. And people make a choice for mechanical, but make it knowing that you still may end up having another surgery. Let the statistics comfort you in your choice - but don't let them lull you into a false sense of security.

And then go live your life!!!!!!