Re: Coumadin therapy after valve replacement surgry

[anonymous-user__0]

Subject: Re: Coumadin therapy after valve replacement surgry

Forum: The Heart Forum


My Husband is needing aortic valve replacment surgery and is very concerned about taking coumadin afterwards. We have a couple of questions. I have read some information about coumadin already and it has promtped these concerns. 1- How restrictive do you have to be with your activity? Is it mostly contact sports that must avoided? 2- Why can't ASA be used as a blood thinner instead of coumdin? My husband has had nose bleeds from being on ASA and vitamin E at the same time. 3- If he wants to continue to take vitamin E after surgery is it allowed? 4- I noticed that there were other drugs that shouldn't be taken with coumadin. Antacids were on the list. Does that mean he can't take an occasional one for GI upset? 5-What if he needs an anti-inflammatory drug? 6-I had heard that someone was making a machine to monitor your PT a home (sort of like the glucometer). Do you know anything about this? Thank-you for your information.




Dear Laura,
Firstly, I have read all these tidbits of advice that you have received under your
forum questions, and Todd has a good point, i.e. has valve repair been considered?
Valve repair is a fairly new surgery, but it AVOIDS a replacement.  It is most
successful in the mitral position, and often not a possibility in the aortic position.
Another response (preceeding mine) speaks of the longevity of a homograft being
15-20 years (THIS IS COMPLETELY UNPROVEN), as well, it is unlikely and I would not
recommend you do anything but ask your husbands surgeon what are  the options, and
what specifically are the risks and benefits of each option (for instance, the advantage
of a homograft is that there is no coumadin requirement, but surely there will be a second
operation to re-replace the valve.  And a prosthetic valve requires coumadin daily but it
is often the valve of choice in young patients since it can last forever!
Keep in mind that there are millions of patients out there on coumadin, most with no problems at all.
NOW READ THE RESPONSE FROM NATHAN WHICH IS EXCELLENT ADVICE, PROBABLY COULD NOT HAVE SAID IT BETTER MYSELF.
AND FINALLY I WILL ANSWER YOUR SPECIFIC QUESTIONS (but do keep in mind what Nathan says, i.e. the responsibility is yours
to pay attention to your daily diet, to take precautions that protect your body from serious injury, etc.)
1. Any activity that could produce harm to the head, like biking or skiing should be done with extreme caution, i.e. WEAR A HELMET.
Contact sports like rugby are probably out of the question as you can imagine since it is very difficult to exercise caution in such a sport.
The point is that, for a patient on coumadin, the risk of bleeding is significantly higher than for the person not on coumadin.  A bleed that
can not be stopped easily with the application of pressure (in the head or in the stomach-internally) is life-threatening.
2. ASA works on a different portion of what biologists call the coagulation pathway, and in head to head studies, asa did not provide the
protection from clotting on the valve that coumadin did.
3. Vitamin E like other drugs may or may not affect the amount of coumadin your
husband needs to take, this is a very individual thing, however, for any drug that the patient needs to be
on, so long as the physician is aware of all drugs being used and so long as the drug is taken on a regular basis,
the level of coumadin will remain steady.  Often when a patient who is taking coumadin wants to start a new medication or
over the counter medication, it simply requires that the bleeding time (INR) be checked more frequently to see if the coumadin
dosage needs adjustment or not.
4&5. Antacids can change the absorption pattern of the coumadin, thus so long
as the antacid is taken 4-6 hours before or after the patient takes his or her
coumadin, AND so long as the antacid is not taken on a regular basis, the coumadin dosage
will not need adjustment. Again, keep the physician who is following the levels informed, so that
if and when it comes to having to take antacids regularly, this can be investigated and treated in and of
it's own right, as well the levels will have to be checked more frequently.
As for the over the counter pain relievers (tylenol and anti inflammatory drugs)
these can (but do not always) increase the effect of coumadin and should therefore not be used
on a regular basis without consulting your physician.
6. There is technology that allows a coumadin INR check with the ***** of a finger (not a blood draw from the arm),
but I am sure it is quite expensive; if the cardiologist does not know of its' availability (some cardiologists have them in their offices now)
you might inquire with the pharmacist, even just for the manufacturer's name whom you can call.  Of course, this type of machine would avoid
blood draws for your husband at the local lab or hospital, however the levels need constant evaluation by his physician and the physician needs
to feel comfortable that the machine correlates with the true blood level as determined by a blood draw.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.









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