Confusion over coumadin

[mattmack]

To introduce myself - my name is Matt and I had MVP surgery a little over three weeks ago. I'm doing well, and in spite of countless aches and pains, I feel a decent amount of energy already and life is ever so slightly returning to normal. I'm very happy to have found this forum, as it feels great to be amongst helpful and supportive folks who have had similar surgery.

But I do have some lingering questions that my docs (cardio-surgeon and GP) seem to have opposing opinions on..
Prior to surgery, my cardio-surgeon explained the different possibilities for my situation - metal replacement valve, or repair of the natural valve along with the advantages and disadvantages where applicable. Much to my surprise, he was able to repair my valve. I was told that this was ideal because it would now not require me to take life-long anti-coagulents. In recovery, I've been put on toprol and coudamin and told that it was temporary while I heal, and I should be off of both in a few weeks. Great!
About a week ago, I went to my regular GP doctor for a check up and he told me something completely different about the coudamin. I would have to be on it for a long time (a year at the very least) if not indefinitely even with a repair.
He told me that it had less to do with the type of repair/replacement done and more to do with the blood flow of the heart now that it has been altered(??) Hmmm...I was told something very different by the cardio-surgeon (off the coudamin in about 4-8 weeks according to him). Who do I believe?
If it comes to taking the coudamin, I'll take it for as long as I must, it sure beats the alternative! I'm just a tad puzzled though at having been told two different things.
Has anyone here had a similar experience, or perhaps can shed some light on why the two docs might have such a different stance?

 

[Mary]

To introduce myself - my name is Matt and I had MVP surgery a little over three weeks ago. I'm doing well, and in spite of countless aches and pains, I feel a decent amount of energy already and life is ever so slightly returning to normal. I'm very happy to have found this forum, as it feels great to be amongst helpful and supportive folks who have had similar surgery.

But I do have some lingering questions that my docs (cardio-surgeon and GP) seem to have opposing opinions on..
Prior to surgery, my cardio-surgeon explained the different possibilities for my situation - metal replacement valve, or repair of the natural valve along with the advantages and disadvantages where applicable. Much to my surprise, he was able to repair my valve. I was told that this was ideal because it would now not require me to take life-long anti-coagulents. In recovery, I've been put on toprol and coudamin and told that it was temporary while I heal, and I should be off of both in a few weeks. Great!
About a week ago, I went to my regular GP doctor for a check up and he told me something completely different about the coudamin. I would have to be on it for a long time (a year at the very least) if not indefinitely even with a repair.
He told me that it had less to do with the type of repair/replacement done and more to do with the blood flow of the heart now that it has been altered(??) Hmmm...I was told something very different by the cardio-surgeon (off the coudamin in about 4-8 weeks according to him). Who do I believe?
If it comes to taking the coudamin, I'll take it for as long as I must, it sure beats the alternative! I'm just a tad puzzled though at having been told two different things.
Has anyone here had a similar experience, or perhaps can shed some light on why the two docs might have such a different stance?

Welcome Matt, and congratulations on your mitral valve repair!

I don't know the answer to why your GP would give you contradictory advice concerning the length of time you will be on coumadin, but I would ask my surgeon once again at your 6 weeks post-op visit and then ask your cardiologist.
My PCP, who I've gone to for 25+ years and I trust implicitly, told me quite honestly that he was not current with all the new advances in valve surgery and I would hazard a guess that is true for yours also.
Once again, welcome to VR!

 

[Bina]

Hello Matt and welcome!
I am on Coumadin for life with a mechanical aortic valve.
My feeling is that I would follow the recommendations of the cardio/surgeon before the GP since it's the surgeon who was in there and knows exactly what is going on with your valve and heart.

 

[ALCapshaw2]

What you convey from your Cardiologist sounds a bit "bizarre" to me (I'm trying to be polite). Do you have other local choices for cardiologists?

The usual recommendation for repairs or tissue valve recipients is to be put on Coumadin for 3 months following surgery unless there are accompanying irregular Heart Beat issues, especially Atrial Fibrilation, which is another common cause of clot formation that requires anti-coagulation for protection.

'AL Capshaw'

 

[Freddie]

Hi Matt and Welcome.

Sorry I can't help you, I just want to welcome you to this amazing site/forum.

Never be shy. No question is ever dumb.

 

[mattmack]

Thanks for the replies so far everyone!

AL C - I agree whole-heartedly (no pun intended) that it sounds bizarre.
What you had written about the "usual recommendation" seems to make the most sense out of anything I've been told to date.

 

[Bina]

Matt, it is very early at 3 wks postop to be making any decisions on your need for Coumadin.
Talk to your cardio again in 2 months. He will re-evaluate the situation.
Better safe than sorry!

 

[Jkm7]

A big welcome to you. Happy you found us and hope your recovery continues to go well.

I am 8 weeks out from mitral valve replacement with tissue valve. My Surgeon, Cardiologist and Primary Care all agree I should take coumadin for 2 to 3 months and if nothing develops in the interim (such as a-fib) I can stop it. I saw my surgeon about a week ago and he told me to stop in one more week.

 

[Lisa in Katy]

I agree that you should have a cardiologist following you long term. They are more likely to be up to date than a GP. Although I have a replacement, when my docs were considering a repair, I was given the same information that your surgeon is giving. The advantage is that most people with repairs do not require long term Warfarin, although this shouldn't be the only deciding factor, because there are patients who do need it.

 

[Ross]

Matt unless you developed a clot, afib, or had mechanical valve installed, you should be off the Coumadin in 3 months or less. Your GP needs to go back to school and pay attention during valve replacement class.

 

[Philip B]

Contradictions

Contradictions

Your cardiologist is the one I'd put my confidence in if I were you. I don't have much confidence in my primary care GP when issues involving my repaired heart are involved.

-Philip

 

[jds]

MV Replacement (for me) was 8 weeks of coumadin

MV Replacement (for me) was 8 weeks of coumadin

Hello -

I got a tissue valve replacement for my Mitral and was on coumadin for eight weeks. My surgeon recommended this and my cardio and PCP said it was fien with them.

I think it is the time needed for the stitches internal to the heart to heal over although I never asked about this.

I was never on heparin (at least not after getting out of cardiac ICU). Heparin has the same general effect as coumadin of decreasing clotting so, normally, you don't need to take both if the use is purely prophalactic. But I think heparin is always injected so I would rather take coumadin if I had my druthers - I still remember the heparin bruises all over my belly from an earlier hospital stay.

John