Pregnancy anyone?

[Guest]

Three pregnancies with mechanical heart valve and no follow-up in 10 years.Akhtar RP, Abid AR, Zafar H.
Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan. J Coll Physicians Surg Pak. 2007 May;17(5):292-3.

Anticoagulation and proper INR (International Normalized Ratio) monitoring is essential for patients having mechanical heart valves; it is vital in these patients in order to prevent lethal complications such as valve thrombosis and systemic embolism. In pregnancy, it becomes even more important as pregnancy itself is a hypercoagulable state. This report describes a female patient having undergone mitral valve replacement with a Starr Edward metallic prosthesis. She came back to the operating surgeon after 10 years of valve replacement with a history of three uneventful healthy deliveries and no follow-up and INR monitoring during this period.

This shows how little we know about this rat poison.

A Starr-Edwards in the mitral position is highly thrombogenic.

It isn't clear whether she took warfarin or not. It just says that she never had her INR checked.

 

[bvdr]

Al, when my neurosurgeon and I were discussing how we will handle my anticoagulation needs he mentioned that in some countries people don't receive anticoagulation with valves????? He also said he did have one man(also a valve patient) have a big stroke during the period his warfarin was being held for surgery. I can't imagine he is right on no warfarin being used unless it is a very remote location or maybe a third world country and the sytems just wouldn't be in place. I would think in those conditions that there wouldn't be many artifical heart valves either. Isn't warfarin use pretty universal as far as valves go?

 

[Mary]

Thanks Al, but I think I'll pass on the pregnancy offer!

On a serious note, I am thankful that I made it through five successful pregnancies before learning that I had a valve that needed replacement.

It's always good to know that you're up to date with anti-coagulation research. You never know when any of us might need it!

 

[Marty]

Al, I remember a post here years ago about a man from India who had a prosthetic valve replacement then went home which I think was deep in the countryside and never came back for post op care. Eventually he was found about 30 years later doing fine and had never taken warfarin.We need a study where 100 prosthetic valve patients take no ATC and match them over ten years with 100 patients taking warfarin. Why is it I think this study will never be done?

 

[tobagotwo]

It's always been a percentage chance, so it makes sense somefolks will get by without it. More salient: what are the genetics these people have that allow it? Maybe valve recipients will take a DNA test that would make warfarin optional for some.

In a number of countries, the people have no money for drugs, and no ability to get to (walk to) a clinic, much less pay for home testing equipment. Their chance of stroke and death may be higher than someone who is on ACT, but their odds with no valve replacement were zero. Still a huge improvement.

The reason you likely won't get much on that type of study is the same reason that fellow had no Coumadin for 30 years. He walked away. It's hard to get followup on folks who just walk away.

Still... it would be nice to know...

Best wishes,

 

[RCB]

Al,
I would bet if she wasn't having her INR checked, she also wasn't having a brain scan. After I had my stroke, they found several smaller and older strokes.

I can't remember, but I don't think that poor soul who went for years with
no ACT, ever had a brain scan.

Marty,
You know why there will never be that study, because everybody follows you to sign up for the control group!

 

[Marty]

Al,
I would bet if she wasn't having her INR checked, she also wasn't having a brain scan. After I had my stroke, they found several smaller and older strokes.

I can't remember, but I don't think that poor soul who went for years with
no ACT, ever had a brain scan.

Marty,
You know why there will never be that study, because everybody follows you to sign up for the control group!

You guessed it. I would volunteer for the control group!

 

[ALCapshaw2]

On the lighter side -

AL, are you offering to produce the pregnancy (does your wife know?) or just do the followup study?

 

[ALCapshaw2]

On the lighter side -

AL, are you offering to produce the pregnancy (does your wife know?) or just do the followup study?

On the more serious side -

I'll bet there are studies from (South) Africa.
I KNOW that studies from South Africa were made comparing the results with On-X valves vs. older mechanical valves and the stroke rates were significantly lower with On-X. That is ONE of the reasons I've chosen On-X as my first choice for MVR.

'AL Capshaw'