Coumadin... Pros & cons

Hi! I'm pretty new to this site (just joined yesterday). I'm in the process of deciding if I want a tissue or mechanical valve for my aortic valve replacement surgery. One of the main issues I continue to deal with is Coumadin. Is anyone on this medication? If so, can you please tell me the pros & cons. My surgery, right now, is scheduled for October 20. Thank you!

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I've been taking Coumadin almost 2 years, since I had an aortic valve replacement in 2009. I freely eat whatever salad or vegetables I want (and I've never met a vegetable I don't like) and have had almost no problems with my INR being stable.

I thought I was leaning towards a tissue valve; however, surgeon said to me, at my age, I would need two if not three additional valve surgeries if I chose a tissue valve. That was the deciding factor for me. I am very grateful for the direction my surgeon gave me on choosing a valve.

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May I ask how old you are? I'm 40 & I was told almost the same thing. I'm so confused now after reading so many different things online. Thanks for your input.

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Welcome to the site no one wants to join. Ultimately the decision is between you, your family and your docs about whether to go with tissue or mechanical but I commend you for doing your research.
I have 2 mechanical valves since 1999. I have a love/hate relationship with coumadin because life affects coumadin, more than just your intake of vitamin K. If you look into past discussions there are quite a few focused on coumadin, warfarin and managing INRs. They should be very helpful as you make your decision.
I wish you well in this challenging time, but I suspect, if your docs say you need your valve replaced, you'll feel a whole lot better when all this is behind you. Best, Rudy

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Hmmm... i'm following your posts after my stumble on it and my timely talk with someone who knew someone... yeah, prob not the best info!! ; ) sorry was hoping to help! I can see what Antigone is saying. She had hers replaced in her 40s. You will have to personally weigh the pros and cons of the mechanical and tissue valves. I can see how this can be confusing...always seems one thing is better for one...then one thing bad for other... uggghhh. In the end I think something will tell you what is right for you.

All I can say is keep nudging input from others who have been there and I will pray for some clarity for you!
Light and love your way!- Annette

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Thanks Annette! I truely believe that I will have a clear answer before my surgery. I believe that my surgeon was placed before me by God, so I refuse to believe he won't give me THE answer for this too. Appreciate the thoughts & prayers!

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Hi Kedmonds,

with your belief in God I believe you can't go wrong with your decision. When I needed my cabg I let go and Let God. I had total confidence in the surgeon He picked for me. I will keep you in my prayers. shamrock

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It is a big decision. Coumadin takes a lot of managing. You can eat leafy greens as long as you are consistent with how much you eat. Chow on a giant mess of greens once in a while and your INR will dip with the influx of Vit K. Every single medication you ever take must be checked for interactions. The interactions with Coumadin are so complex that health care providers pretty much have to look up everything. The good news is we're getting close to some alternatives to Coumadin that may be easier to manage, new drugs that do not require such frequent blood work, that do not have such widely varying doses between different people, and that have less frequent bleeding complications. Pradaxa was approved for anticoagulation for A-fib. Your doc might be able to tell you how many years in the future a similar alternative for people with valves will be. For now you have to take a hard look at your life and the commitment you can make to sometimes weekly lab work, monitoring your diet to keep vit k intake at a consistent level, remembering your exact dosage of Coumadin (many people have to take different doses on alternating days or a bigger dose once a week), and being proactive about checking for interactions for every new medication. Some activities might have to be altered. I friend of ours had to give up his wood working hobby because of the risk of severe bleeding if he cut himself on a saw. You know your lifestyle and what commitments you can make best.

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Thanks! My surgeon did tell me about the new drugs on the horizon, which was nice to hear. I think I've heard just as much good as I've heard bad... That's why I'm confused. You come on these forums hoping to help with your decision & instead I'm more confused. Lol!

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I'm getting off Coumadin next week! Yippee. Down to Plavix and aspirin. I think the Coumadin tends to make you tired easy. Is it just me or does anyone else feel this way? I'll know next week when I get off it...

Good Luck on your thing I know is don't mess with the meds while in crisis..take them and then let your doctor know you want to get off them as soon as possible...and to let you know if there are natural or common sense solutions to taking some of the meds. An example of this is my doc wanted to put me on some steroid drug because I was feeling lightheaded on beta blockers. When I forced him to talk and explain it to me he had to admit that #1 the beta blockers were lowering my BP too I could really just stop taking those and I would probably be fine...and that the reason he was giving me the steroid was because it would make me retain water and make my BP go up! But he also admitted I could just eat more salt with every meal and that would do the trick too...!!!!!

So, my point is that he was going to have me on one drug that was causing a problem and another drug to fix that problem, when the most common sense solution would be to just take me off the first drug and have me eat a little salt!!!

Goes to show that you have to be pro-active and don't get bullied by doctors and ask questions even when they seem annoyed and want to wrap everything up in 6 minutes and cover their butts by putting you on every med under the sun!!!

Again...good luck...stay strong!
Rachel Willen

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I was 51 when I had the surgery. At that age, surgeon said a tissue valve would mean an additional 2 or 3 valve surgeries. At your age, it could be more. The younger you are, the more likely a tissue valve lasts a shorter time. If you don't mind having another 3 or more valve surgeries, get a tissue valve. It is not an easy surgery, and when you need replacement, you have no idea what your health status will be at that time.

Though a mechanical valve is not a guarantee you will never need an additional surgery, they rarely fail. The only reason you may need it replaced is if too much scar tissue develops on it, something not very common.

Taking Coumadin is no big deal. It's far easier than going through valve surgery several more times. At least that's my NSHO.

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I had an aortic valve replacement 7 months ago. St. Jude's mechanical was what the docs decided for me, because they thought I was young and this should last a long long time. Silly me, I did not do research ahead of time on coumadin and know no one who takes it, so did not realize it needed so much monitoring. (I thought it was like a maintenance drug, ie. claritin) So, I was surprised at all the blood tests and drug adjusting that was needed.

I had a real hard time getting to the proper level and have had a few rounds of lovenox shots when it gets too low. Now I am a bit high with my readings, but better high than low. I have a limited diet due to severe colitis, so I do not eat things with much Vitamin K, but my levels fluctuate alot. Everything seems to have an effect - exercise, stress, life. . . so it is important to follow doc's orders with testing and dosage. I hear there is a new drug which will be out in about a year or two - specifically for people with valve replacements and will require no testing. Keeping my fingers crossed.

Since I do not have any other heart issues or problems, it is comforting to know that my valve will last for life. A co-worker had the same surgery with a pig valve 6 weeks after mine and he worries about when he will need replacement- but he does not take coumadin anymore (only first couple of months)

There are certainly pros and cons for each type of valve. I am sure you and your doctor will make the right decision.

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Thanks anniegee! Yes, there are pros & cons with coumadin. Glad to hear you are doing better with your levels. That is something that is worriesome, the constant testing, getting the levels right, watching the food you eat, etc. My cardiologist did tell me about the drug that is supposed to allowed for valve patients. I think he said it's Praxada (sp?). It's already being used for Afib patients. My cardiologist & I agree that a mechanical valve sounds like the right choice for me. I do NOT want to pick a valve knowing that I will definately have to go back & have another surgery, possibly several. Just doesn't sound good to me. Thanks for posting!

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I've been on Coumadin for 10 years now. I self test and self manage my dosing and am followed by my cardiologist.

The worst thing about Coumadin is, most of the medical profession does not know how to manage it properly. If you get a great manager, your problems will be few. If you have a poor manager, your INR's will yo yo and you'll be testing all the time. This is when you know that you need to find another manager.

The secret to dosing is really laughably simple. Eat like you always have and the dose will be adjusted for your diet. Too many people are told silly things like, they can't eat greens or things high in vitamin K and it's total rubbish. You should try to remain consistent, but I'm anything but that and I can keep my INR in range 85%+ of the time. When I went to the clinic, I was in range only 45% of the time. Home testing gives you tighter control and better overall management. Test no more then 2 times a week. Anything more is a waste because it takes Coumadin 3 days to show it's full affect in a test. I will gladly help anyone who is having a hard time getting into and staying in range. I am not a doctor, but I have a lot of experience and had some of the best teachers.

As for Tissue vs Mechanical:

Mechanical valves are designed to last a lifetime, though as mentioned, it does not guarantee you won't have to have another surgery. I, myself, have a St. Jude Mechanical valve that I got when I was 40. Reasons for replacing a Mechanical can range from pannus growth impinging the leaflets, clot formation if not properly anticoagulated, and infections. It does however, give you the best possible chance of never having to go through another heart surgery. The down side is, lifelong anticoagulation, but I'll take my anticoagulation any day over another surgery. I've been through 2 now, once for a dissecting ascending aortic aneurysm and then for valve replacement 7 years later.

Tissue Valves: If your younger then 60, you can plan on up to 4 or 5 more open heart surgeries. They do not last long in younger people. I've seen them fail in as little as a couple weeks and as long as 7 years later. The pro is, you won't have to take anticoagulants for life.

Let me be frank with you and please don't misinterpret my meanings here. The human body was not meant to be cut on over and over again. The more surgeries you have, the more commorbidites you will have. This is one surgery that should only be done 1 time if it can be helped. Your other internal organs take a hit each time your subjected to more surgery.

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Looking at some of these postings, I'm compelled to respond to those thinking there will be alternatives to Coumadin/Warfarin for valve patients in the future.

Pradaxa is new. There is no way to test how effective it is and in New Zealand, it's already caused 5 deaths. I'm betting this drug and others like it, will be pulled from the market in a year or two. Coumadin has been around for 50+ years, can be tested for effectiveness and in my opinion, is safer then throwing something into you and not knowing what the outcome will be.

What is happening is, by prescribing Pradaxa and others like it, it takes the responsibility off of the physician and places it squarely on the patient. If all physicians were on the same page when it comes to dosing Coumadin, there wouldn't be this need to get away from Coumadin, but that's the sad reality of life.

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"Why we should stick to Warfarin" ,This article was in New Zealand News Papers yesterday.

Doctors hyave been "pushing" the new blood-thinning drug Pradaxa before its side-effects are fully known, says the son of a man who is fighting for his life in Tauranga Hospital after suffering an adverse reaction to the medicine.

The body representing general practitioners has admitted they are on a "learning curve" on how to use Pradaxa and it will be years before they have full knowledge of its effects.

A Sunday Star-Times investigation has found that at least four elderly heart patients have died, and dozens have suffered bleeds, after switching from the anti-clotting drug warfarin to the new-generation medicine Pradaxa, also known by its generic name, dabigatran.

Pharmac fully funded the drug from July after it was approved by government medicines regulator Medsafe, and since then many people have reported adverse reactions, ranging from gastro-intestinal problems to major bleeds. Medsafe says it had expected adverse reactions, but believes the benefits of the drug outweigh the risks.

Clinical trials have found that at certain doses, Pradaxa has lower rates of bleeding and risk of stroke than warfarin, and its other main benefit is that it does not require continual blood tests.

But it cannot be monitored and surgeons and haematologists are alarmed that there is no antidote to reverse its effects in the event of a major bleed.

GPs have been criticised in some cases for prescribing Pradaxa for patients at higher risk, such as those over 75, with poor kidney function, low weight and replacement heart valves.

The Star-Times has heard reports of medical clinics transferring patients from warfarin to Pradaxa en masse after presentations by Boehringer Ingelheim, the company which produces the drug.

Harry Pert, president of the Royal New Zealand College of General Practitioners, said he could not comment on "anecdotes", but confirmed there was enthusiasm for the new drug.

"People have been waiting for an alternative to warfarin for a long time. It's not the greatest drug, and if there's something that will do the job as well, or better, then we should be considering it."

He rejected the suggestion that patients were being used as guinea pigs. "They're not being used as guinea pigs, medicine is always changing, always progressing and we're always learning, that's the way medicine works. If you sit down and have a conversation with the patient and say `there is this new medicine, these are the potential harms and these are the potential benefits, what would you like to do?' I don't think there's a problem with that."

Ad Feedback But Chris Thompson of Whakatane, whose 77-year-old father, Rod, is fighting for his life in Tauranga Hospital after an adverse reaction to Pradaxa, said elderly patients tended to take what their GP said as gospel, and it appeared doctors were "pushing" Pradaxa. His father, who was otherwise fit but took warfarin for a heart rhythm disorder, switched to Pradaxa on the advice of his GP.

He began suffering lower back pain, which turned out to be a kidney infection, and was eventually admitted to hospital with total renal failure. He has come close to death and remains in intensive care. Chris Thompson said two GPs who saw his father after the symptoms began did not associate them with Pradaxa, and it was not until he was admitted to hospital that the Pradaxa connection was made.

"If the GP had known more about the side-effects, monitored it more and made the changeover more gradual, they may have picked up the fact he was responding adversely to it. He got quite sick before they realised what it was. If they'd been monitoring the patients more thoroughly ...they could have taken him off it and he'd probably be fine today." The GP involved declined to comment.

Pert said the college sent material to all 4000 members on how to prescribe Pradaxa safely. "With the introduction of a new medicine, there's always going to be a learning curve as people get to grips with how to use it, when to use it and when not to. We don't want to delay unnecessarily access to a potentially important new medicine, nor do we want to rush into it."

He said that although Pradaxa was a good option to consider, evidence suggested that patients over 75 who were stable on warfarin "might be perfectly happy staying on it. It comes down to individual choice".

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