Need input on warfarin & "elderly"

shop deals on amazon
Shop deals on ebay
Advertise with us
Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
catwoman

catwoman

VR.org Supporter
Supporting Member
Joined
Sep 23, 2003
Messages
6,024
Location
near Fort Worth TX
(My husband, John, has been swamped at work this week and not able to go online to look at vr.com. I did walk him through the website Tuesday night at home. His screen name is catman, BTW. :D )

John said he only wants to have OHS once, and therefore, if his MV can't be repaired, he's leaning heavily toward a mechanical. I'm investigating those and have spoken with my surgeon's nurse. We'll see Dr. Matter when John gets results of his TEE, scheduled Feb. 1.

I tried to do an INR test on him Tuesday night, but didn't get large enough of a drop of blood. Will repeat next Monday (interested in his INR now) and so he can really see what it's like.

John will be 61 in March. His dad died @ 79 from cancer, had MVR twice. His mom died @ 64 from Alzheimer's (yeah, very young).
I know the surgeon will have some input on what type of valve, but John should get the valve he feels most comfortable with.

Any comments on anticoagulation therapy in seniors?

John walks about 2 miles a day during a break at work, does the mowing, but that's probably the most active he is. He's very consistent in what he eats. Has never taken any kind of chances. Never had any cavities or teeth pulled -- honest!! He's very good at seeing our PCP.

I just wonder about warfarin with senior citizens -- that is, very senior senior citizens. John doesn't want to have another surgery at 75+, if he can help it.

Nancy, Al Lodwick, anyone?
 
Hi Marsha,
I don't post much but lurk almost every day.
Don;t know if I'm "senior" enough for your question.
I'm 72. Had MVR (St Jude) in 1997 been on coumadin since.
Started home testing w/InRatio 13 months ago. Just now
learning to keep my INR fairly stable. No problems.
If you have any more specific questions please feel
free to ask.
Paul
 
So long as he is healthy and has a working mind, there shouldn't be any major problems. The biggest thing with older folks, and I wouldn't classify him in that stage, is falling down. If he uses common sense like the rest of us, he should be fine.
 
Joe tolerated anticoagulation for 29 years. It was when his body started to break down, in this past year or so, that EVERYTHING started to get quite dicey. Joe was, as you probably know, 75 years old, and had had rheumatic heart disease since he was a teenager.

I can truthfully say that Coumadin had nothing to do with the medical problems leading up to his death.

However, as his body started to slowly break down, he became sensitive to Heparin. This is my own opinion, and testing did not reveal any Heparin induced thrombocytopenia, or other Heparin sensitivities.

He developed liver, spleen, renal and pulmonary problems, which were not related to Coumadin, but were related to his overall heart disease, and he also had EXTENSIVE heart and lung problems. I think that the liver and renal problems had something to do with the possible Heparin sensitivity.

He developed a brain bleed while on Heparin in Oct. 2006, which he recovered from for the most part.

He had also had a major bleedout after being on Lovenox a couple of years ago.

I am not sure that Joe's experiences are ones to judge your husband's future on. I would imagine that it is apples to oranges.

If your husband is in good health otherwise, and is a good patient (compliant), IMO he should do just fine. And you already know about how to handle INR stuff. That's a BIG plus.
 
Geriatric warfarin

Geriatric warfarin

Marsha, as you know I had mitral valve replacement in 1998 when I was 72. My surgeon discussed the type of valve I should receive with his partners and a split vote went to mechanical.The surgeon said he did not want to see me on his table in my 80's. I am now there and greatful to him. My St. Jude mechanical has worked well with no problems. The warfarin has been no problem since my cardiologist set me up for self testing two weeks post op.
One thing your husbands doctors must understand is that the starting dose post-op is lower for older people. At one time they started with a "loading dose" of 10 mgm per day. Then they came down to 5 mgm. That may still be too high. It was for me. I found in the literature that it is best to start at 2.5 mgm and work up from there.This should decrease the risk of a late post op bleed. My daily dose now is 3mgm.Tissue valves are getting better and better but I still hear of some of them failing as early as two years.Of course if you are on warfarin the hope is that you won't need other kinds of surgery. I was lucky in this regard. My only problem post op was a leg muscle bleed after a fall. It was no fun but is OK now.Feel free to contact me with any other questions. Marty
 
One of our members mentioned that his surgeon suggested to GO ON COUMADIN to see 'how he did with it' BEFORE making his Valve Choice and having surgery. Sounds like a GOOD PLAN to me. I'm surprised more people are given that suggestion.

I am already on Coumadin for my St. Jude Mechanical Vavle in the AORTIC position. My MITRAL Valve is now failing.

Because of the greater propensity for CLOT formation at the Mitral Valve, I have asked my surgeon to implant an On-X Valve in the Mitral Position based on considerable data showing 1/3 to 1/2 the Morbid Event Rate for On-X vs. any of the other valves on the market. See www.onxvalves.com for more information and contact info.

I recommend contacting Catheran Burnett at [email protected] or 888-339-8000 ext 265. Catheran is a former Surgical Nurse (from Baylor) and worked for St. Jude prior to moving to MCRI, the manufacturer of the On-X Valve. Ask her to send you an Information Package similar to what she sent to Al Capshaw. It contains charts comparing valve performance in several critical areas for 5 different mechanical valves. They also publish a very thorough informational booklet on Valve Surgery that includes a balanced view of the Mechanical vs. Tissue Valve issues. On-X will also be happy to send information and / or meet with your surgeon.

'AL Capshaw'
 
Marty said:
Marsha, as you know I had mitral valve replacement in 1998 when I was 72. My surgeon discussed the type of valve I should receive with his partners and a split vote went to mechanical.The surgeon said he did not want to see me on his table in my 80's. I am now there and greatful to him. My St. Jude mechanical has worked well with no problems. The warfarin has been no problem since my cardiologist set me up for self testing two weeks post op.
One thing your husbands doctors must understand is that the starting dose post-op is lower for older people. At one time they started with a "loading dose" of 10 mgm per day. Then they came down to 5 mgm. That may still be too high. It was for me. I found in the literature that it is best to start at 2.5 mgm and work up from there.This should decrease the risk of a late post op bleed. My daily dose now is 3mgm.Tissue valves are getting better and better but I still hear of some of them failing as early as two years.Of course if you are on warfarin the hope is that you won't need other kinds of surgery. I was lucky in this regard. My only problem post op was a leg muscle bleed after a fall. It was no fun but is OK now.Feel free to contact me with any other questions. Marty
Click to expand...

Interesting information Marty.

I expect to be having MVR sometime soon (months) and am already on Coumadin for my St. Jude Mechanical Valve in the Aortic Position. My surgeon generally does NOT do BRIDGING Post-Op but said he would support whatever I wanted to do. He had no problem with my local Coumadin Clinic setting up a Bridging Schedule for BEFORE surgery.

Do you have any information of personal views on BRIDGING following OHS?

'AL Capshaw'
 
Al:

My surgeon hasn't implanted any On-X valves; his nurse says another surgeon in the same practice has.

The FDA clinical trials on the On-X started last summer and are to go through 2015. I doubt we'd be basing a decision to go with an On-X valve just for the hopes of decreased warfarin.
 
Al:

Left a message to get info on the On-X.
My husband's already said he wants Dr. Matter to operate on him. Matter and Dr. William Ryan -- who's done a lot of Ross procedures on folks here -- are among the top cardiovascular surgeons in Dallas, as rated by their peers.
Wonder what it take to get a surgeon to use a different type mechanical valve?
 
heart valve

heart valve

When my father had his MVR in 1999 we discussed both bio and mech valves with the surgeon. We decided on St Jude Mech. We were told by the surgeon that if he went with bio (pig valve) there would be a good chance that it would have to be replaced within 10 years from insertion. Dad did very well with the St. Jude mech valve and never had any coumadin issues until it was stopped for a colonoscopy. You know the rest of the story. As far as coumadin dosing in the elderly, Marty is right on. Elderly people usually require lower dosing to get to and stay in range. Be carefull not to let a physician take lower dosing to mean lower INR. Below are some links for coumdin dosing protocol in the elderly.

http://www.fpnotebook.com/HEM180.htm

http://www.acc.org/qualityandscience/clinical/guidelines/valvular/jac5929rec48.htm

http://www.acc.org/qualityandscience/clinical/guidelines/valvular/jac5929rec49.htm

http://circ.ahajournals.org/cgi/content/full/107/12/1692

http://www.americangeriatrics.org/directory/ABIM/GRS/anticoag.htm
 
catwoman said:
Al:

My surgeon hasn't implanted any On-X valves; his nurse says another surgeon in the same practice has.

The FDA clinical trials on the On-X started last summer and are to go through 2015. I doubt we'd be basing a decision to go with an On-X valve just for the hopes of decreased warfarin.
Click to expand...

My surgeon has not implanted an On-X valve yet either. I will be his FIRST. (TWO VR.com members have also been firsts, RandyL at Cleveland Clinic and another in Colorado.) He did meet with the Ox-X representative, is impressed with the engineering and 5 year TEST DATA which shows the lowest Morbid Event Rate of any currently available valves. BTW, there have been 50,000 On-X valves implanted worldwide over the past 10 years and 5000 implanted in the USA over the past 5 years.

There is an especially interesting study from South Africa (which has been posted on VR.com by someone else) where there is a substantial under-educated and / or non-compliat segment of the population. Results with the On-X valve show markedly reduced risk of STROKE vs. other mechanical valves. THAT is the REAL Benefit from the On-X Valve. Hemolysis compares with Tissue Valves and is about 70% of the level of competing Mechanical Valves. Lower Anti-coagulation Levels is a secondary benefit.

WHATEVER valve you select, I would encourage you and your husband to obtain the study results and FDA Data Submissions from On-X (or any other source you may find). Look at ALL of the data. Then make you selection.

'AL Capshaw'
 
My mother-in-law took warfarin for at least 15 years before she died at age 85 of old age non-heart related issues. She took it after she developed a blood clot in her leg after having had elephantitis for a few years in both legs. Anyway, she didn't develop and warfarin problems to the best of my knowledge. Marcie
 
Marsha

Marsha

Will tell the story again after 5 years and close to 5,000 posts.:D I was age 61..when they found my aneurysm....The surgeon told my family..At her age..she does not need to go thru this surgery again......They agreed..and I have a mechanical valve and have been on Coumadin for 5 years with NO problems.:) ......You have the home-tester..if he decides to go mechanical.I only test now once a month. Today was the same as last month. 3.5..and take 5 mg a day for the last 5 years. never any change in doseage. In fact. I called it in to my clinical Cardio's nurse today..Cardio scripts my coumadin (Warfarin)Ashley used to call me back..but..now she knows same old/same old.:D .....no need to call me back:D I am sure that you have read my posts of taking care of Grandkids, ect.so, I don't consider myself as being a Senior:p at age 66...sometimes..they cannot keep up with me.:p Bonnie
 
I talked with Ms. Burnett this afternoon. She's sending me info & said she could even have a sales rep get with the surgeon.

Told her we believe the valve problem is related to the car accident, and she told me about a soldier (in Iraq, I think), who was involved in a car accident, I believe it was, and had to get a valve replaced. Then went on to compete in a triathlon...
 
At 61, I would not consider him a senior. The average age in my clinic is 70. So I manage lots of people in their 80s. My oldest was 106 - not a valve patient.

I would not expect that he would need an age-related warfarin dosage adjustment for about 20 years - if he remains active.

If he has never had a bleeding ulcer, or a brain injury I would not expect any problems. There isn't really any proof that old ulcers or brain injuries make any difference, I was just pointing out that you have to have a pretty bad medical history to worry about warfarin.
 
Al:

Thanks. And, no, I don't consider my husband a "senior" -- at least not now. He's almost 4 1/2 years older than me, and I had my surgery @ almost 53 (1 month short). So, he will be 8 years older than I was when I had my MV and closer to "senior" status than I was.

What is your oldest valve patient's age? Just wondering. (See separate thread here.)
 
Can you top this?

Can you top this?

They operated on the great Dr. DeBakey in Houston for aortic aneurysm and I think replaced the valve. The details are in a NY Times article published a few weeks ago. There was heated discussion pre-op but when the surgeons decided to go ahead they had to go outside their hospital to find an anesthetist willing to put him to sleep.DeBakey survived the surgery but had a stormy postop course. I think he is still alive and hope his quality of life is satisfactory. DeBakey is 99!
 
Thanks, Barb, for finding this. I thought I read it in the NY Times a few weeks ago but did not remember details including Dr. DeBakey's age!
 
You must log in or register to reply here.

Latest posts

Back
Top