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coumadin and aortic valve replacement
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coumadin and aortic valve replacement

In 1991 I had my aortic valve replaced with a St Jude Valve.  I have been taking Coumadin ever since and I have PTs every month.  I am supposed to have my Thyroid removed next month and my current cardiologist says I can get off of my coumadin for a few days for the surgery.  He does not believe I need to be taking heperin (spelling?) at this time.  I always thought that I could not get off of my coumadin without taking heperin.  Can I stpo taking coumadin for a short time??
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This is a matter of judgement. The standard teaching certainly used to be that someone in your situation would be brought into the hospital and maintained on heparin until the time of surgery, with resumption of heparin, and coumadin, as soon as it was safe from a surgical perspective. This is the safest way to proceed and would be my official answer. However, I am aware that many doctors now no longer follow this principle, realizing that the risk of clot formation in a few days for an old St. Jude's valve in the aortic position is quite low. The risks are higher for certain other types of mechanical valves and valves that have been freshly implanted, as well as for valves in the mitral position. People who have previously had a clot form would also be at much higher risk for it to happen if coumadin is again stopped.
9 Comments
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Avatar_n_tn
Hi
I had a MVR this year. I was removed from my Coumadin for two days when my blood got too thin. I dropped down to 1.5, not good for my valve. I ended up in the hospital on Heparin. I had to go off for a recent GI test. I was able to use a Sub Q drup called Lovenox while off the Coumadin. It is a short lived Heparin like drug that you can administer at home. Usually twice daily. I did this for a total of two weeks until I was stable. It seemed to work for me. It's very expensive, but better than the alternative. If CCF reads this, how do you feel about Lovenox??

Thank you
Gina
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Avatar_n_tn
I had my aortic valve replacement March 1999.  Since the first I experience a lot of pain in chest still.  Not the same as before my surgery but yet pain, sometimes less-sometimes worse.  I also have this feeling of pain and now for about a week of numbness or tingling going from my shoulder to the tip of my fingers in my right arm.  Does anyone else experience this?  Also, problem with severe fatigue?  Would love to return to work/career but can't seem to shake all this.  Is it normal?  How many more of you experience this and what answers have you received?
Thank you, DM
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Avatar_n_tn
My husband 49 y/o has had mitral valve replacements x 5 and the aortic valve has been replaced x 1 all within 14 years.  His last surgery 2 surgeries were at the CCF witht he last surgery being was 3 months ago with a good outcome.  He had atrial fib/flutter prior to his last surgery and after.  His CCF cardiologist recommendation cardioversion after 6 weeks which our local cardiologist could handle.  My husband had the cardioversion locally and was converted with one zap.  All has been well.  Currently only meds: coumadin 5mg, cordarone 400 mg x 1, lasix 40mg x 2, K+, accupril 5mg x 2, Dilantin 100mg x1.  

However, last week he was in the cardiologists office for a visit and his first local echo since surgery and his pulse rate dropped to in the 40's several times.  His local cardiologist wants for him to have a pacemaker.  He had tried to talk my husband before surgery into a pacemaker but my husband is not in favor of having anything else implanted in him that he doen't absolutely need.  My husband has had just about every complication from valve surgery: endocarditis x 2; stroke; seizure; and his aortic valve is a bjork - shiley involved in the manufacturer defect class action suit. (The CCF surgeon has looked closely at this valve and says no sign of fracture and as the surgeries where very long for one valve, the aortic valve has not be replaced again.)    

Prior to surgery, his CCF cardiologist said they would prob. implant a pacemaker during surgery.  That did not happen and I really do not know why.  Pacemaker was discussed after surgery and the cardiologist said he didn't think at that time he needed one.    

I know we could return to CCF for evaluation and maybe the pacemaker implant. However, we where there in October for 3 weeks and it does get a little expensive.  Financially, we are still recovering.  My husband has returned to work, he owns his own business and that suffers when he is not there.  His local cardiologist has told him he would probably need to be in the hospital for about a week - to get off coumadin, onto heparin, have the pacemaker procedure (30 min procedure), back on heparin and to restart coumadin.  My husband has been through so much, we would like to stay local if we can.  He could keep an eye on business, our kids and it would help us financially.

My questions:
Does it appear to be clinically indicated for a pacemaker?

With his extensive surgical history, how difficult will it be to implant a pacemaker?  

Any suggestions as far as make, kind?

With his low heart rate, he did not feel any differently?  How long can he drag his feet?        

Thanks for your time and any advise you may give.





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Avatar_n_tn
I have a question moreso than a message.  I had an aorta valve replacemnt in April, 1997.  I have been SOB since early spring, 1999 and was told I had pulmonary hypertension.  I have had all kinds of test including a right sided heart caterization which indicated i have disatolic dysfunction.  I understand that my left ventricle is "stiff" which affects the right side of the ehart which in turn affects the lung.  my questions is could the diastolic dysfunction have resulted from the aorta valve insufficiency?  I never had these problems until I had been on fen phen for 2 years.
Pls respond to ***@****
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Avatar_n_tn

I have corrective inguinal hernia surgery scheduled for June 27. My physcian recommended that I stop taking Coumadin (which I take because of an aortic valve replacement -- St. Jude Valve) six days before the procedure.  Is this too long, considering I had oral surgery and the surgeon recommended that I stop two days before that and I started back on the Coumadin the afternoon after the surgery, without any problems.  (The surgeon has not yet provided a recommendation on when I stop taking Coumadin.)
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Avatar_n_tn
In 1992 I had a St. Jude metal valve replacement for mitral and aorta and I am told that I have to have a tooth pulled. Can I go off the coumadin for 2 days to have it pulled? What should my PT be if I don't go off the coumadin?
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Avatar_n_tn
In 1993, I had my aortic valve replaced with a St. Jude valve. I now have macular degeneration.  I have read that eating spinach every day may slow down the macular degeneration.  However, spinach contains vitamin K. Should I be concerned about taking both coumadin and eating spinach?  Ernie
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Avatar_m_tn
A related discussion, aortic valve replacement while on coumadin was started.
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