Hi
The odds of experiencing a "Bleeding Event" are much higher with a mechanical valve than with a tissue valve.
well I would suggest you get a grip on what is much higher ... when compared to who?
*people who have vascular disease?
*elderly vs youth
*people who have had a stroke (and therefore gone onto thinners) vs not?
its tough ... and the literature doesn't really help without you getting in and reading more than the abstracts. You have to be critical and ask questions while you read. Its like an orange, the juice doesn't come out by just looking at it.
One PhD thesis I read had at least some sort of definition:
Twelve of the major bleeding events occurred in the ICAD group (incidence rate 4.2/ 100 person-years), 5 in the TRODIS group (incidence rate 1.8/ 100 person-years). This yielded a relative risk of 2.3 (95%CI 0.8-6.5) of excess bleeding in the ICAD vs. TRODIS group. In the ICAD group 5 major bleeding events were gastrointestinal, 2 haematuria, 1 severe nose bleed and 1 severe skin bleed. In the TRODIS group there were 2 severe nose bleeds, 1 respiratory tract bleed and 1 retroperitoneal bleed.
notice also how lower his numbers were for bleeds ... his thesis was about better anticoagulation management. I find that the more I read the more conclusive it is that poor management practices of warfarin are the significant influence in higher bleed events (with respect to tissue vs mechanical valve patients, I'd exclude the other types of vascular disease patients as that adds a layer of complexity which is perhaps not relevant to someone who simply has aortic stenosis).
His TRODIS warfarin managed group have bleeds which approach (and in some cases better) the typical US literature reviews of tissue valve candidates...
I assumed they were more frequent due to the use of Warfarin but tissue recipients also have them.
I guess that you mean heart valve replacement people in the mechanical vs tissue. You need to be careful because MUCH of the literature addresses people who are on warfarin but are NOT heart valve recipients. The vast majority of people on warfarin are not heart valve patients
What specifically is a Bleeding Event and what is done to repair it?
Usually nothing is done except reduce coagulation therapy and wait. Just ask Gail for starters.
as to what is a Bleeding Event ... well when blood comes out of where it shouldn't. If that seems flippant its not. For example from:
Standardized Bleeding Definitions for Cardiovascular Clinical Trials
A Consensus Report From the Bleeding Academic Research Consortium
American Heart Association, Inc. 2011 (
url)
Lack of standardization makes it difficult to optimally organize key clinical trial processes such as adjudication, and even more difficult to interpret relative safety comparisons of different antithrombotic agents across studies, or even within a given trial, because results may vary according to the definition(s) used for bleeding
{my underline}
I found a study which has results you may be interested in:
(
URL)
Methods/setting: This study included 16 513 patients with a first diagnosis of AF between 1 January 2005 and 28 February 2010 (newly diagnosed patients) using data from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and the Office for National Statistics mortality data. Exposure was stratified by vitamin K antagonist (VKA) exposure (non-use, current, recent and past exposure)
...
The incidence of bleeding event hospitalisations was
3.8 (3.4 to 4.2) for current VKA exposure,
4.5 (3.7 to 5.5) for recent,
2.7 (2.2 to 3.3) for past and
2.9 (2.6 to 3.2) during non-use;
so during the time they were not using it their incidence of bleeds was 3.8/100 paitent years while in non use and in their past it was 2.7 anyway...
