Posted by CCF Cardio MD-SGM on August 11, 1997 at 01:27:50:

In Reply to: Coumadin and Heart Valves posted by Andrea on August 05, 1997 at 14:39:33:

: My Dad (70 years old )had a heart valve replacement some months ago and
they initially offered him either an artificial or animal valve, with
the proviso that he would have to take coumadin for the rest of his
life if he chose the artificial valve.

The wind up is that he chose the animal (pig) valve and is on coumadin
anyway ad infinitum. When asking the doctors why... we really don't
have much of an understanding of their response. Any feedback you
can provide would be much appreciated. Thanks in advance.

Andrea

Dear Andrea,

Sorry for the delay in answering your question. Coumadin, as you know, is a potent blood thinner that is used in a variety of conditions where there is an elevated risk of blood clot formation. Blood clots are very worrisome because they have a tendency to travel away from the location where they initially formed (the heart or the deep veins of the legs) and cause damage to distant organs(the brain-- stroke, or the lungs-- pulmonary embolism, for example).

Certain heart valves require anticoagulation(blood thinning) with coumadin to lessen an increased risk of blood clot formation. These are usually the mechanical, or metal, valves. Now, if your father received a bioprosthetic valve which is made from animal tissue, you are correct in your understanding that coumadin would not typically be required. However, it is possible that he suffers from another condition that would necessitate anticoagulation. Such conditions include a history of blood clot formation in the heart or veins, atrial fibrillation(irregular heart rhythm), and possibly severe dysfunction of the main pumping chamber of the heart-- the left ventricle. The last indication is the least solid of the three I mentioned.

Remember that therapy with coumadin is not without risk, and the benefits of this therapy(decreased risk of clot formation and stroke) need to be balanced with the principal risk-- bleeding. You should ask your doctor which specific indication for coumadin is at issue in your father's case. If you like, call the Cleveland Clinic Heart Center at (800) CCF-CARE to make an appointment with a cardiovascular specialist to help further in addressing this question.

Have a nice day.