A question for doctors out there...metal versus natural..

[Elfster]

Mainly related to doctors, but if anyone else has a thought that could be helpful, amusing, interesting or whatever they can join in as well.

I know someon who will soon be heading off for a "aortic valve replacement for biscupid aortic valve stenosis"

Should they go for a metal valve or a bioprosthetic valve??? It does seem like warfarin is a bit of a bitch...though so too is getting hacked open again in 10 - 15 years.

Any thoughts appreciated....

 

[philsale]

As far as I know, the decision does generally come down to that idea of the timeline to replacement. That and any real contraindications to therapeutic anticoagulation.

How old is she? Any other medical problems - heart/lung/kidney disease, etc? Already on anticoagulants for any reason? Willing/able to to take warfarin and undergo the regular blood tests and doctor visits required? Takes part in any activities that would mean anticoagulation is not recommended, or has a history of falls?
These are all things that she and her surgeon need to take into account when they are deciding which to go with.

 

[cyclopath]

Another perspective - Warfarin is all very well, but as a surgeon, the increasing number of patients on Warfarin creates massive headaches for us. Most of what we do requires cessation of the Warfarin, and the incidence of bleeding issues after surgery is high as they often need to recommence it soon after. Not a light decision to commit to many years of Warfarinisation.
Tough call.

 

[Inside Shoulder]

Another perspective - Warfarin is all very well, but as a surgeon, the increasing number of patients on Warfarin creates massive headaches for us. Most of what we do requires cessation of the Warfarin, and the incidence of bleeding issues after surgery is high as they often need to recommence it soon after. Not a light decision to commit to many years of Warfarinisation.
Tough call.

why are there an increasing number of patients on warfarin?

 

[cyclopath]

More conditions are being treated with Warfarin now than in the past, even going back 10-15 years; patients live longer; my patient base is primarily older with many over 60-65 years old.

 

[Inside Shoulder]

More conditions are being treated with Warfarin now than in the past, even going back 10-15 years; patients live longer; my patient base is primarily older with many over 60-65 years old.

I know its to stop clotting but what are the medical conditions in the general population that lead to an increase in the rate of clotting - or whatever it is that necessitates prescribing warfarin?

 

[Elfster]

Thanks guys for the info.

Taking the above on board and doing a bit more reading I think my own recommendation would be the natural valve.

According to the surgeon there is a chance of further surgery in about 10 years...the life of the natural valve. There is dilation of the aorta - it is around 4cm - and thus that may have to be replaced. So if future surgery is inevitable it makes sense to go the natural way.

Also probably need to consider that in ten years time advances in medical science may obviate the need of such intrusive surgery. Though that could also be said of the adverse effects of warfarin.

I have been told that with warfarin there is between a 1 and 3 percent chance of a 'major bleeding incident' - which would require a transfusion. And the prospect of having haemophilia type symptoms is not nice.

IS - I am no doctor, but I have been told that with artificial valves there is a good chance of blood clotting on the surface of the valve thus the need of a substance like warfarin.

And warfarin seems like they have just renamed ratsak and started givving it to people.

Cyclo, in which hospital do you serve?

 

[boyo]

Warfarin is often prescribed if a patient has atrial fibrillation (AF) , which is a heart condition that can cause clotting. I think that it is used for several other conditions that involve clotting.

 

[cyclopath]

I know its to stop clotting but what are the medical conditions in the general population that lead to an increase in the rate of clotting - or whatever it is that necessitates prescribing warfarin?

People who have had previous Deep Vein Thrombosis (DVT) and more particularly Pulmonary Embolism (PE) secondary to that; people with mechanical heart valves; Atrial Fibrillation - a reasonably common condition where there is up to a 3% risk per annum of developing clot within the chamber of the heart due to the inefficient contraction of the heart when fibrillating, with the risk of the clot travelling out of the heart and most commonly up the carotid arteries, leading to a stroke. There are large numbers of patients on Warfarin for this.
There are other uses, but those 3 would be the most common.

@Elfster - several!! PM me if you really want to know!

 

[Inside Shoulder]

way off topic, cyclo I know, but are the DVTs and pulmonary embolisms that lead to, what i would call, an underlying need for warfarin generally idiopathic or is that a lifestyle consequence or something else?

 

[cyclopath]

way off topic, cyclo I know, but are the DVTs and pulmonary embolisms that lead to, what i would call, an underlying need for warfarin generally idiopathic or is that a lifestyle consequence or something else?

Some relate to environmental factors - airline travel, long car trips etc due to stasis is the veins , primarily in the lower leg. Some occur secondary to surgery from immobility / swelling of the legs etcc causing stasis. Some are related to underlying abnormalities of clotting factors in the blood leading to an increased propensity of the blood to thrombose. By far and away most are in the first 2 categories.

 

[Inside Shoulder]

thanks

 

[Cave Dweller]

What advice did your doctor give you?