Hi
GA Mom;n868143 said:
Pellicle, thank you for your reply. To the best of my knowledge, I have no other issue that could cause my INR to be difficult to determine. The PA drew quite a bit of labs today and will discuss and analyze my clotting disorder (again) with the surgeon.
good move ... also, keep in mind that the surgeon is specialised in what he does, so will not actually be well versed in blood disorders. To use Neil's metaphor its like asking your gearbox specialist about your fuel injection issue ... it may just be that he knows nothing about it and someone here may.
As to the size of valve I'll need, I don't know that yet but I plan to ask tomorrow.
like I said its a factor, probably a small risk, but ask about putting in the biggest one he can, explain why and if you are prudent print the paper and take it with you (just to see how he changes his approach to you when peer reviewed journals are submitted by a patient).
As to pannus, I think I read that the On-X valve has a coating to help reduce the risk of the development..
well to be blunt all the valve makers are trying to make their product appeal more on the market. They will naturally draw attention to side issues (meaning that blood flow and operation are the primary ones) which may or may not have any evidence gathered to determine them.
What about my last theory: If I decide on the mechanical valve, am I increasing my odds to have blood clotting issues since I am already predisposed to them?
as I wrote in my earlier response "indeed, I would agree with your logic. " As Agian has observed its treated commonly with warfarin, so (as you've pointed out) you may end up on warfarin anyway. Looking at your condition and looking at the locations that warfarin interacts with Factor V (while other anticoagulants do not seem to, and are more down stream) then it would seem that its likely that warfarin will remain the drug of choice for your treatment of that disease.
As explained
here:
Direct Thrombin Inhibitors
[FONT="]The coagulation protein factor II, also known as thrombin, is part of the common pathway of coagulation. Prothrombin is converted to thrombin by factor Xa and factor Va.[SUP]9[/SUP] The primary function of thrombin in coagulation is to convert fibrinogen to fibrin, a compound that is involved in the formation of clots.[SUP]9[/SUP] Thrombin is also involved in activating factors V, VIII, XI and XIII, as well as binding to thrombomodulin and activating protein C[SUP]9[/SUP] (Fig.1).[/FONT]
So this would to me make wafarin a strong candidate to part of your future either way, so to me you'd be better off with a mechanical valve than a tissue valve because the prime reason to select a tissue valve is to avoid the
horror of AC therapy (sorry about the dramatic, but I get the shits with the horrorfied anti warfarin folk who have never been on it and only justfiy their arguments with the worst stats.)
A blood clot could still form even though I would be taking Coumadin, correct?
Yes, but clotting can't be stopped entirely as this would have very dire health consequences. The point however is to reduce likelyhood of "thrmobo-genesis" and slow the process down to allow the natural mechanisms present in the body to break down clots where they should not be (NB floating around in veins).
Also there is the point that
tissue prosthetic valves are not immune to causing thrombosis., as I understand it something like 5 or 10% of tissue valvers are on wafrarin for non AF related thrombosis issues So its even perhaps more likely that your condition would predispose you to requiring warfarin on even a tissue valve.
The bottom line of the decision making process is this:
informed patient decision.
Let me quote from:
Guidelines on the management of valvular heart disease (version 2012)
2.3 How to use these guidelines
The Committee emphasizes that many factors ultimately determine
the most appropriate treatment in individual patients within
a given community. These factors include availability of diagnostic
equipment, the expertise of cardiologists and surgeons—especially
in the field of valve repair and percutaneous intervention—and,
notably, the wishes of well-informed patients. Furthermore, due
to the lack of evidence-based data in the field of VHD, most
recommendations are largely the result of expert consensus
opinion. Therefore, deviations from these guidelines may be appropriate
in certain clinical circumstances.
my bolding. But the points of informed patient and lack of evidence based data highlights that the opinions of practitioners are exactly that ... personal biases which are not supported by scientific evidence in many cases. (in support of agains suggestion that many cardios are also opinionated wankers as well as being MD's who have undertanen a speciality training)
