Would love On-x But...

[cwm123]

I am having 2nd valve surgery at the Cleveland Clinic Nov 16th. My first valve replacement was in 2004 (48 yrs old) at the Cleveland clinic and I chose a carpentier-edwards magna tissue valve. I was out of the hospital in 4 days. I am now 60 years old and if I choose another tissue valve that would place me for my 3rd AVR between 70-75 years old. The only medication that I have been taking is celebrex for lower back. I cannot get off of it because that would alter my quality of life. I have researched and know that coumadin cannot be taken with celebrex. I would choose an On-X if I could take celebrex. Would like to here your views on this from memebers and pellicle. Thanks guys!

 

[Paleowoman]

Hi cwm123 - welcome to the forum ! I can't advise you on specific valves, I leave that to others, but I am most interested that you got your CE Magna valve when you were 48 and it has lasted you 12 years !

Did you have symptoms indicating that you needed a new valve replacement ? And what kind of symptoms and what kind of measurements showed you needed a new valve? I realise this is an imposition of me as this was not the reason you posted here, sorry.

PS - I see it's only a few days till your surgery - you haven't got much time to decide on the valve, that must be awful.

 

[cwm123]

Delos Cosgrove (which is now the CEO of the Cleveland Clinic) in 2004 suggested that I go with a tissue because of my lifestyle and that 2nd replacement was not that bad. I had an echo in March and the cardiologist said that the valve was looking good. In August I started to have palpitations like I had in 2004. I went for and echo at Vanderbilt (where I work) again and found that the valve was starting to deteriorate. Right now I am looking to have another tissue put in but would like to have the On-X.

 

[Heart Of The Sunrise]

cwm123- Wow tough decision. A third AVR at 70-75. More power to you. I have the ON-X VALVE. all is well. Coumadin has not been a problem. I was very fortunate that I did not have to go with another valve due to the necessity to take other medications.

 

[pellicle]

Hi
I think you are being guided by broad brush stroke and not having careful thought put into your management.

http://www.fda.gov/Drugs/ResourcesFo.../ucm072436.htm

Q. Should Celebrex be avoided in patients receiving warfarin or similar products?

A. Patients receiving warfarin can also receive Celebrex. Since Celebrex by itself does not affect platelet function or bleeding time, it can be an appropriate treatment option for patients taking warfarin, as long as the anticoagulation effect of warfarin is maintained at the proper level. To minimize any increased risk of bleeding, patients should be closely monitored (especially in the first few days) to see if any adjustment of their warfarin dosing is needed.

Q. What does this mean regarding the overall safety of Celebrex?

A. Patients receiving warfarin require monitoring of the level of anticoagulation produced by that drug. It is not unusual for them to need a change in warfarin dosage when there are changes in the other medicines they are receiving. Celebrex does not pose a unique or special risk in this regard, compared to other medicines that patients may receive. It is important, however, that patients who are receiving warfarin and then start taking Celebrex (or who have any other change in the other medicines that they are taking) be monitored for changes in the level of their anticoagulation, with adjustments in the dose of warfarin if necessary.

This is what all of us who self monitor do, check closely. Also this is why he establishments in the US get poor results (still) by persisting with outdated policy of not fostering self testing in capable patients.

Sadly your story of pushed towards tissue prosthetic when younger and then getting less than 15 years is quite common here.

You have but a few days to make your call, but raise that information with your team and become informed as to the specific issues relating to you ... One size does not fit all

Some food for thought

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

 

[Paleowoman]

I had an echo in March and the cardiologist said that the valve was looking good. In August I started to have palpitations like I had in 2004. I went for and echo at Vanderbilt (where I work) again and found that the valve was starting to deteriorate. Right now I am looking to have another tissue put in but would like to have the On-X.

So it would seem it deteriorated very quickly all of a sudden :-( I hope you get a valve you'll be happy with. I had my AVR when I was 60 and chose a tissue valve becasue I wanted neither warfarin nor the ticking noise of a mechanical valve. I chose the tissue knowing fully I'd need a re-do by the time I was 72 to 75 - I wouldn't be a candidate for TAVR valve in valve as my valve is only 19mm so would it be another OHS for me, but only my second.

 

[Warrick]

hi I just googled the celebrex warfarin interaction which I assume you have already and found this
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/QuestionsAnswers/ucm072436.htm
Q. Should Celebrex be avoided in patients receiving warfarin or similar products?

A. Patients receiving warfarin can also receive Celebrex. Since Celebrex by itself does not affect platelet function or bleeding time, it can be an appropriate treatment option for patients taking warfarin, as long as the anticoagulation effect of warfarin is maintained at the proper level. To minimize any increased risk of bleeding, patients should be closely monitored (especially in the first few days) to see if any adjustment of their warfarin dosing is needed.

Q. What does this mean regarding the overall safety of Celebrex?

A. Patients receiving warfarin require monitoring of the level of anticoagulation produced by that drug. It is not unusual for them to need a change in warfarin dosage when there are changes in the other medicines they are receiving. Celebrex does not pose a unique or special risk in this regard, compared to other medicines that patients may receive. It is important, however, that patients who are receiving warfarin and then start taking Celebrex (or who have any other change in the other medicines that they are taking) be monitored for changes in the level of their anticoagulation,
So as a lay man to me it appears it is doable it just needs the right management with warfarin same as alot of drugs with warfarin

I have finished 3 different lots of pain killers a week ago from my wire removal (all may or may not interact with warfarin) and no change in my INR and then weekly self test on friday and gone from 2.5 to 3.2 so its essentially taken 2-3 weeks to show an effect but with weekly testing I'm able to pick that up and make dose adjustments before it gets unsafe.
Hope all goes very well for you.

 

[cwm123]

Thanks Warrick and pellicle for the info from the Food and Drug report. I found that report about one month ago but have not found any other reports confirming celebrex use with warfarin. I have been through every journal you could think of. I will bring this to my teams attention. I have not had a chance to talk with them about this yet. I will be sitting down with them on Monday.

 

[Agian]

Well people say you can't take Vitamin K with Warfarin. Guess what? I started taking a K2 supplement. Just means I take more Warfarin to keep my INR in range.
Pellicle told me not to 'over steer'... Kind of like being on a rickety boat in choppy waters. It's doable.
I have an On-X too.

 

[pellicle]

Hi

Thanks Warrick and pellicle for the info from the Food and Drug report. I found that report about one month ago but have not found any other reports confirming celebrex use with warfarin.

Suggesting that it is not a problem. Somehow your guys got it into their heads it was a no go. But like many surgeons they are not expert in anti-coagulation therapy but their personal ego usually precludes them admitting that.
Have a good solid chat with them because the bottom line is they advise, you choose. Advice is the basis of second opinions.

I'd hate to see you railroaded in to a decision you would not prefer.

Do not under play the substantial complications in redo surgery created by scar tissue. There is no doubt (none, zero) that it makes subsequent operations more difficult. Surgeons love to talk in risk of death, but death is an extreme outcome from a redo surgery. More likely is you just end up on a pacemaker because they nic your AV node which is a nerve that is critical to heart operations.

Remember too that you will need to push (hard) for self testing, they really are resistant to letting business go outside their network. You will also need to be responsible and diligent in your checking. To me the absence of this in the general population is why tissue is put forward. It's not hard to do (heck I do it) but people can be fops.
Get the data, get information and make a decision you feel comfortable with.

Best wishes

 

[LondonAndy]

I was not familiar with Celebrex, and so Googled it, and frankly if I was on it I would want to try to get off it if the information on Drugs.com is accurate. The effects of long term usage look rather nasty:

Celebrex can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Celebrex may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using Celebrex, especially in older adults. You should not take this medicine if you already have bleeding in your stomach or intestines.

To me, not going through another open heart surgery procedure in my mid 70s would be a priority, and despite the helpful information from Pellicle and Agian I would do all I could to get off Celebrex, or find a safer aternative, and go for a mechanical valve with Warfarin and self-testing.

 

[Agian]

Celebrex got a bad rap a few years ago.
There are other other anti inflammatories you could try. The risks Andy mentions are independent on whether you're on Warfarin or not. Having said that 'google' does not specify the site from which this info was obtained. I always go to pbs.gov.au. Type in Celebrex into the search box.

 

[LondonAndy]

The risks Andy mentions are independent on whether you're on Warfarin or not. Having said that 'google' does not specify the site from which this info was obtained. I always go to pbs.gov.au. Type in Celebrex into the search box.

The information I posted was from Drugs.com, and I provided a link to it (https://www.drugs.com/celebrex.html) , but I agree: these risks are independent of Warfarin, though given the risk of stomach or intestinal bleeding I can understand the reluctance to take both.

 

[Agian]

The information I posted was from Drugs.com, and I provided a link to it (https://www.drugs.com/celebrex.html) [/URL], but I agree: these risks are independent of Warfarin, though given the risk of stomach or intestinal bleeding I can understand the reluctance to take both.

Sorry Andy, I missed the link.

 

[pellicle]

Hi

... and despite the helpful information from Pellicle and Agian I would do all I could to get off Celebrex, or find a safer aternative, and go for a mechanical valve with Warfarin and self-testing.

As I didn't know anything about why the OP was on Celebrex I made no suggestion of shifting from it. I wasn't attempting to advocate for being on it.

Given the above additional information about it I agree that shifting off it (to an alternative) would also be my goal.

The idea of being on warfarin complicating other drug therapies is of course real, and many manifest even in the future as (say someone like me ages and) the need arises.

But complexity isn't prohibiting, it just brings with it a bit of extra diligence in monitoring and some thoughtfulness.

I'm sure you will be able to find assistance for that here.

 

[cwm123]

Thanks guys! I am reluctant to take both because of bleeding. The only other drug that I know of would be to take Hydrocodone (low dose) when I first get up and then Tylenol the rest of the day if needed. The problem is, here in the US the government has come down so hard on using any pain meds and for good reason! I agree that getting off the celebrex would be a great thing to do. Cleveland Clinic wants to put a On-X in me but does not want me on the celebrex because of how harsh a drug it is. I work in the ICU here at home so I have some knowledge about this drug and have always wanted to be off of it. Again thanks for your input! This is helping me to brainstorm before I sit down with my team on Monday.

 

[pellicle]

Cleveland Clinic wants to put a On-X in me but does not want me on the celebrex because of how harsh a drug it is.

I'd go with the Cleveland Clinic opinion too.

I just googled celebrex and got this (yike)

Before taking this medicine
Celebrex can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

 

[LondonAndy]

Sorry Andy, I missed the link.

No problem! And it was sensible that you pointed out the Celebrex issues are independent of warfarin.

 

[LondonAndy]

This is a little bit off topic, but a news alert I get happened to throw up this article about Celebrex that is generally saying good things about it when compared with alternatives. Note, however, that there is no reference to anti-coagulation therapy or replacement valves, mechanical or otherwise.

 

[Nick17]

Hello:

58 years old, have suffered from lower back pain for years, due mainely to excessive driving. I have always tried to deal with the pain to avoid back surgery.

In 2015 I had OHS/AVR 23mm Onx. 2 months post op I developed Pericarditis due to inflammation. Treated with Colchicine for 6mo to control pericarditis inflammation. Worked great, had no back pain and no effect on INR. Two weeks after I stopped the Colchicine, back pain returned with a vengeance. Went back to taking the Colchicine in a smaller dose 0.6mg once a day and the back feels just fine, with no effect on INR range. Check out Colchicine, it’s a more natural prescription drug derived from plants and has been around for over 60 years.

Bottom line I feel great, no signs of pericarditis, no back pain and INR is stable and in range. Able to drive, active and exercise. There are options and alternatives out there that may be right for you…check it out.

The new generation of mechanical heart valves take a lickin, keep on clickin, may afford a One and Done Option and should be considered.

All the best,

Nick