Have on-X valve, going in for lung operation and surgeon says no need to bridge

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Plumber1

Well-known member
Joined
May 3, 2007
Messages
130
Location
Olympia Washington, USA
Sorry, not sure where to post this. The fine surgeon that installed my on-X valve in 2007 needs to get back inside me to review a finding in the right lung. He has prescribed for no need to bridge, just stop Coumadin 5 days prior.

I have greatest confidence in this fellow and am pleasantly surprised at this development. Anyone else heard of this trend?

Thanks. Haven't been on this board for a while but remain big supporter.

-- Mark
 
Whoa...... I only had a short course of coumadin after getting bovine valve but I've done tons of reading here and that scares me. Five days of no coumadin with no bridging is very frightening IMO

Have you discussed this with your PCP and/or cardiologist?
I am not one who 'blindly' trusts what a doctor tells me. They, too, make mistakes.
Sending you the very best wishes for a smooth surgery and all good news.
 
I also would have to question going off coumadin for 5 days with no bridging. I think you are questioning it too, or you wouldn't be asking us. I'd have to have a talk with my cardio and then I would just plain tell the surgeon I was not comfortable with that protocol. It may be fine, but I personally wouldn't be willing to take that chance.
 
No doubt the current performance of the On-X valve is impressive but the surgeons approach seems to be a bit aggressive. In my opinion you would probably be fine going with what the doc says but then again there are no promises just probabilities. I would feel safer with a bridge but then again one day us On-X valvers may have to jump out of the boat and walk on water, in other words take the chance and find out we don't need to be as paranoid as we have been in the past. Truly when will it be okay not to take anticoags with a metal valve, for some of us never no matter what the studies, tests, fda approvals say. For now I'd still think we should bridge because I'm not completely convinced yet but sooner or later this may change.
 
My thought is that it's better to err on the side of caution. A stroke could be mild with almost no lasting effects or it could be very devastating and debilitating; you have no way of knowing. You might not have one at all with no bridging, but do you really want to take the chance?
 
No doubt the current performance of the On-X valve is impressive but the surgeons approach seems to be a bit aggressive. In my opinion you would probably be fine going with what the doc says but then again there are no promises just probabilities. I would feel safer with a bridge but then again one day us On-X valvers may have to jump out of the boat and walk on water, in other words take the chance and find out we don't need to be as paranoid as we have been in the past. Truly when will it be okay not to take anticoags with a metal valve, for some of us never no matter what the studies, tests, fda approvals say. For now I'd still think we should bridge because I'm not completely convinced yet but sooner or later this may change.

Since the early trial results showed about the same number of total "events" but people with the regular INRs had more bleeds while the patients with lower INRs (AND aspirin if I'm remeberring correctly) had more clots/strokes, I would be pretty nervous with stopping 5 days with out bridging even with the ON-X.

As for someday in the future it being OK to use NO anticoagulants with mech valves, the only trials I know of with the ON-X valve and just aspirin were the ones in Germany that they stopped after a patient on the just asprin leg of the trial died of a clot/stroke, and when they started the US trails shortly after that, they did NOT even have an aspirin only leg, I think it will be a very long time before anyone would recomend no anticoagulants, but thats just MY opinion.
 
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Oh, not no, but Hail no don't stop your warfarin/coumadin without bridging. 1mg/kg of body weight every 12 hours is the appropriate dosage for a mech valver for bridging. last dose 16 hours prior to surgery.
Don't let them give you the dosage for a-fib people (like 30 mg every 12 hours). Just 'cause he's a surgeon doesn't mean he knows bupkis about coumadin management. Speaking from personal experience with a GREAT surgeon who knew nadda about bridging and proper dosage.
 
Oh, I should have explained this better.

To be concise the operation will be at a minimum a removal of a section of lung and very, very much more intrusive than a broncoscopy. The area that requires resectioning is composed of a gazillion tiny capilarys with walls so thin as to allow the transfer of oxygen molecules. The risk for bleeding is increased with this procedure. I hope this makes sense..

I will ask about bridging once more but have support of family doc and cardiologist for this process, but understand that my situation is not presented as a normal operation.

Thanks for all the caring and kind words.
 
As for someday in the future it being OK to use NO anticoagulants with mech valves, the only trials I know of with the ON-X valve and just aspirin were the ones in Germany that they stopped after a patient on the just asprin leg of the trial died of a clot/stroke, and when they started the US trails shortly after they did NOT have even an aspirin only leg, I think it will be a very long time before anyone would reccomend no anticoagulants, but thats just MY opinion.

I agree, I don't think we'll ever not have to take anticoagulants. The outcome of the ON-X clinical trials in the US will determine if we ON-X valvers can maintain a lower INR (under 2) without risk of clots/stroke. This is what I am waiting/hoping for.
 
Oh, I should have explained this better.

To be concise the operation will be at a minimum a removal of a section of lung and very, very much more intrusive than a broncoscopy. The area that requires resectioning is composed of a gazillion tiny capilarys with walls so thin as to allow the transfer of oxygen molecules. The risk for bleeding is increased with this procedure. I hope this makes sense..

The risk of bleeding from the surgery is the least of my concerns; the risk of a stroke with no ACT for 5 days, scares the crap out of me.
 
Oh, I should have explained this better.

To be concise the operation will be at a minimum a removal of a section of lung and very, very much more intrusive than a broncoscopy. The area that requires resectioning is composed of a gazillion tiny capilarys with walls so thin as to allow the transfer of oxygen molecules. The risk for bleeding is increased with this procedure. I hope this makes sense..

I will ask about bridging once more but have support of family doc and cardiologist for this process, but understand that my situation is not presented as a normal operation.

Thanks for all the caring and kind words.

First i forgot to mention in my earlier post, i'm sorry you are going thru this again, I remember when they found it before your heart surgery and You'll be in my prayers.
With your history, I thought you were talking about a surgery like that and not a bronch type biopsy, and can understand the concerns about bleeding. So I understand why they wouldn't want to risk increasing the amount of bleeding by staying on coumadin until closer to the surgery, since it stays in for a while. But If it were me or a family member, I would really ask, (or push) about bridging. Either lovenox at home or even being admitted with heprin IV that they could stop a day or so before surgery, seems like it might at least lower the risk of forming a clot and stroke from not having Coumdin for 5 days, but shouldn't increase the risks of bleeding, and as they say you can certainly replace blood cells not brain cells.
 
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Plumber, sorry to hear about the surgery, there are some concerned folks on this thread.

I understand stopping Coumadin 5 days prior, that is a no-brainer for this surgery; but I would think that checking
the INR daily and protecting you with a faster acting anticoagulant, as needed, is a safer route.

For example, if by day 3 of stopping the Coumadin your INR drops to a risky area-- like 1.3-- then a simple Lovenox
shot daily would protect you for that day 3 and the next day 4, while being totally out of your system again by
the Day 5 surgery.
Best wishes whichever way it goes :)
 
Thanks much for this great advice, and for recalling my unusual story here at VR. I will follow this advice and get my INR tested on day 3.

I am nervous going into this surgery... Last time I did this it was quite difficult and at least 3 times harder than my valve replacement. Hard to imagine I would become a veteran at this but know how to pace myself through the recovery process, and how to enjoy whatever fun there is in the hospital.

Again, I appreciate the support, comments and outreach.
 
Plumber,

Do you have a date for your surgery yet?
Please let us know how you are doing.
Hope all goes as well as one could hope for.
 
I am underway on the 18th -- this friday! Expect to arrive to Hospital at 5:15 AM and in dream land by 7:00. Surgery will take anywhere from 2 to 5 hours pending discovery process. Hope to be back home for Thanksgiving.

Thanks for the well-wishes. I will send post a progress report as the Hospital has wi-fi.

Much appreciated.
 
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