Mech Valves and Warfarin

My curiosity more than anything re- those people with Mechanical Valves and if there is anyone who is on a different blood thinner to Warfarin. I've always been told from Surgeons, Cardiologists, GPs and Pharmacists that there is no suitable alternative, but, is that really true?

I've had mech Aortic and Mitral valves since 2013 and been on warfarin since without any issues until recently. Bleeds are few and far between, but, in April I was hospitalised due to a severe internal bleed in my colon. I had been with the virus just prior and my INR spiked to 6.8 when I was admitted. I was immediately withdrawn from warfarin and put on Tinzaparin. Haemoglobin was dangerously low and I was given four units of blood in the next few hours. Sixteen days in hospital and I was to remain on Tinz until I would have a procedure called Angiodysplasia. A couple of weeks after discharge. I had another internal bleed, this time a Haematoma in my buttock, which hospitalised me for a further fifteen days, including two more units of blood. At this point my Cardiologist took over, and placed me back on Warfarin and off Tinz much to my relief. I was on Tinz for a total of 8 weeks, and I hated it, self jabbing in my stomach was messy and sore. Anyway, i was back on Warfarin for week, but, had to revert back to TInz again, once I had the procedure I was then able to get back full-time on Warfarin three weeks ago.

I cant understate how pleased I am to be back on Warfarin, its taken a bit of time to get back in range, but, I'm back in the right place now.

Haemoglobin levels seem to be holding there own, but, I'll see next week when my next bloods are taken. At the moment I feel as well as I have done for a while, so I'm not particularly looking to change anything, just curiosity.

Strangely enough, if anything, I'm probably one of those rare people that have had the virus and some good has come of it long-term.

Cheers

Heed

[Hanibil]

Hi sorry to hear of your problem possibly caused by your INR going to over 6.8,. I have a mechanical aortic valve and have been on warfarin since 2005 with out problem, if you can afford it I would suggest you get your self a Coaguchek machine to do your INR at home, by keeping your eye on it it should never get that high again it will also cut your hospital visits down to around two anyear

[Hidden in reply to Hanibil]

Hi Hanibil, thank you for your reply, it is much appreciated.

Yes, self-testing it is something I thought about a few years ago, but, decided it wasn't for me, although, never say never, as I get older. To be honest, I'm normally within range, the best part of the time, and we've put this one down to a combination of factors all coming at the same time. I only live 5 minutes from the Warfarin Clinic/Hospital so it's not an issue with visits, and when in range I tend to be on 6-8 week appointments.

Although, if I lived some distance away, or it was a struggle making appointments, I would probably go for self-testing.

Thanks for your suggestion anyway.

Heed

[Shar28]

Hello. Warfarin is the only anticoagulant for mechanical valves. None of the new anticoagulants have been tested and approved for this purpose.

My husband is on Warfarin for his mechanical Aortic valve and recently had a colonoscopy when a polyp was removed and then bowel surgery. For the colonoscopy he had a bridging programme with Exonaparin/Clexane injections then back on Warfarin the day after the procedure. The day he had both anticoagulants he started bleeding and spent a few days in hospital via A&E/resuscitation. The solution was to stop both overnight then reintroduce Warfarin alone.

As part of his pre-op checks he saw a different cardiologist to his named cardio consultant, who said that as he has a new type valve he doesn’t need bridging with Enoxaparin, just stop the Warfarin and recommence after surgery. However, the surgeons gave him Enoxaparin after surgery in line with the Anticoagulantion Department instructions and as soon as he had Warfarin again he had bleeding too. He was at home by then so just stopped both anticoagulants overnight then restated Warfarin alone the next evening which sorted it.

The new cardiologist is on the hospital’s anticoagulants committee and knew the guidelines and that they are on the hospital intranet but it appears the anticoagulantion department and other surgeons aren’t aware of this.

It might be worth your while checking with your cardiologist if you have a new type valve and asking what the hospital intranet guidelines are so.

By the way, the NICE website contains info and guidelines including this link

bnf.nice.org.uk/treatment-s...

Best wishes to you and your loved ones.

[Hidden in reply to Shar28]

Thanks Shar, Some interesting points, actually I do recall you posting about your husband after his valve surgery, I trust he has recovered well.

My wife has worked in Pharmacy for years and with my recent misadventure, the question popped up again why don't I ask for an alternative to Warfarin. My response has always been that there isn't one. To be honest I'm happy enough with Warfarin and just see this as a blip in the grand scheme of things.

Similarly to your husband, I also had a colonoscopy or two in my case and had a Angiodysplasia procedure, and a single polyp removal whilst they were in there. Again, I hope he has recovered from his procedure. This is where I was put on Tinz for the second time. Anyway I'm back to normal now, and hopefully my bloods will have improved next week.

I'll have to recheck what type of valves mine are, but, they're coming up to 9 years old, so I don't think they'll be the newish ones.

Both of you take care.

Heed

[dubsta]

Hi, sorry to hear your news, sounds like you have had a tough time. Unfortunately i am not sure if there are alternatives to warfarin that have been tested, worth doing some research though. My INR has gone the other way, 1.3 but now up to 1.6 but ive been having to inject my stomach daily with Enoxaparin plus take warfarin. Ive been doing this for a week and continue until at least Monday! Going to clinic 2 times per week. Its such a nightmre and worry as i am only 10 weeks post op with a mechanical valve. Just want INR to get into a normal place! Good luck with yours and i will start to look at alternatives to warfarin. X

[Hidden in reply to dubsta]

Hi dubsta, Thank you for your reply.

I've had worse, but, I have bouncabilty and keep on coming back for more. To be perfectly honest, I think it's a lot harder for my wife, she has the hard bit.

Hopefully, your INR will be within range in the next few days. Normally, once it gets to 2.0 they'll stop the secondary injection.

I appreciate that you'll be worried, with being 10weeks post-op, but, they'll get you there and once it all settles down, it does become a lot easier.

Please, whatever, you do, don't look at my OP and think Warfarin is a problem, Nine years on it, this is the first time I've had an issue, and that was due to a culmination of things.

Once you get used to it, you'll quickly find what your body can and can't do.

Hopefully by now, you're feeling the benefits of surgery with a good recovery.

Take care and best wishes.

Heed

[Zuzio1]

Hello, at the moment there is a trial with Apixaban on the ONX aortic mechanical valve in the US. they will report the first results by November this year. If the trial works, ie shows apixaban is as good as warfarin, some patients will be able to switch to Apixaban. The advantage is no INR testing, less interactions than warfarin and smaller chance if a brainbleed. The aristotle trial for AFIB patients suggested 75% less chance of brainbleed when you experienxe trauma to the head. The disadvantage is that you have to take the pill twice a day and if you forget it, there is no protection (only protects for 12 hours at a time). So we will need to wait till November to see if there is an alternative