On-X Aortic Heart Valves: Safer with Less Warfarin On-X Aortic Heart Valves: Safer with Less Warfarin

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  • #91
    Originally posted by Homeskillet View Post

    Yes, forgetting a dose is a key concern for me. Told my wife tonight that I need her to keep some Coumadin in her purse at all times so that if we're out late eating I can still take it close to the same time. I do wonder if there's a "grace" time period each night (e.g., 1, 2, 3 hours?) of taking my daily dose.

    Or, what if I somehow completely miss a dose - what on earth do I do then? ER?

    Also read that warfarin is actually rat poison! Say what??

    Honestly, really just having a hard time w. all of this right now.
    First off, the "take it in the evening" standard is just a thing that came about. I honestly don't know why. Very early on, I knew evenings wouldn't work for me. I was barely 18, I had a job after school, I had friends I was going to hang out with, I knew morning would be the most consistent time. Even with that, though, I've never been a clock puncher on that. If I get up at 6:00, I take it before I leave the house. I've never resisted an opportunity to sleep in though, and sometimes that meant 9:00 or later, in my younger years. Point being, if you have a time of day that you know you're more likely to be in the same place, then make that your time. Don't let them force you into the evening shift if it will be harder to stay consistent. Over 26 years later, I'm still correcting the Coumadin Clinic when they say, "Okay, for tonight's dose..."

    I think it might be because it's viewed as an "elderly with heart problem" drug, and all patients are at home getting ready for Wheel of Fortune and Jeopardy, back to back - so 7:00 PM is perfect! But besides pellicle, who really knows?

    Second - regarding missing a dose. Happens to everyone at one time or other. I promise, you will do it too. And you will survive. There are a few ways to deal. If I think of it early enough, I'll just take it when I remember. If I don't remember until the evening, I might take a half dose, then start back normal the next morning. If I miss completely, I might just resume my regular dosing (depending what my last INR was), then be sure to test in a couple days. At an INR of 3 or better, I've got some downside wiggle room to absorb a miss. I have never called or gone in to ER over a missed dose.

    The only time I went to urgent care in over 26 years due to Coumadin was when I did two really stupid things. One I didn't know was stupid. First, I had gone two months or more since my last test. Prior to that, I had been stable for months on the same dose. Home testing didn't exist at the time, and I didn't make time to get to the lab. The second thing was only stupid because of the first. I chose that time to get on a glass a day of cranberry juice kick. My urine had become a dark brown color, indicating blood. Turns out my INR had spiked to around 10!

    Notice though, that bad things didn't just happen because I was on Warfarin. They happened because I was an irresponsible patient. And the juice wasn't the problem either. It was the lack of testing. Had I been testing frequently, I would have changed my dose as soon as I showed and INR over 3.5. It never would have climbed that high.
    10/15/2009 - St. Jude Medical Valve / Conduit Graft 25mm. Dr. Robert Hooker Jr at Meijer Heart Center, Spectrum Health Butterworth Hospital, Grand Rapids, MI.

    September 2009 - diagnosed with 4.9 cm ascending aorta with two aneurysm bulges.

    11/21/1990 - St. Jude Medical Valve 23A-101. Dr. Seong Chi at Ingham Regional Medical Center, Lansing, MI.

    Aortic Stenosis and BAV diagnosed in infancy.

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    • #92
      Originally posted by Superman View Post
      Notice though, that bad things didn't just happen because I was on Warfarin. They happened because I was an irresponsible patient. .
      I agree with everything Superman says. He and I have both been on warfarin for a long time and I referenced his quote above to reinforce that problems with warfarin are usually due to irresponsibility on the part of the patient. My one, and ONLY, bad experience with warfarin was my own irresponsible behavior.......the drug did not jump up and bite me for no reason......but I'm a quick learner and I learned to be responsible real quick.
      Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Drs. Richard Wood & Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery with no diet, lifestyle, or activity restrictions....and I live one day at a time.

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      • #93
        Pellicle,

        After I went off warfarin 6 months after my surgery I had shortness of breath on one of my evening walks. This was about 7 weeks after going off warfarin. A week before that I noticed a slight difference in my walking and running but thought it was just a bad day. The next day after the shortness of breath I felt normal but didn't walk. That night I was breathing heavy and went to the doctor the next morning. End of story was I ended up in the hospital and tests found my leaflet had thickened so it didn't move (stenosis). I had fluid in my lungs. The surgeon visited me and said he saw this one other time and put me on heparin. I remember after about 4 days I noticed a change. I was put on warfarin after that and was able to do a hard walk a week after the 6 day hospital stay so I knew it was better. I had a TEE after that and all was normal again. I recently changed cardiologists and the new one was around the hospital during my surgery and knows the surgeon. He told me that my body reacted to the valve or something on the surface of it. So I guess the warfarin keeps my body from trying to cover up the foreign material. It's a somewhat rare reaction according to the cardiologist. That was 4 years ago and no problems since. That's why I'm on warfarin. I did have afib a couple days after the surgery but it was only for about 30 minutes and the nurses said it was common for mitral valve replacements. I'm on a beta blocker to help reduce the possibility of getting afib.

        Martin

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