Bleeding Event?

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Elgato

Well-known member
Joined
Mar 7, 2014
Messages
53
Location
Tucson, AZ USA
The odds of experiencing a "Bleeding Event" are much higher with a mechanical valve than with a tissue valve. I assumed they were more frequent due to the use of Warfarin but tissue recipients also have them.

What specifically is a Bleeding Event and what is done to repair it?

Thank You
 
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...
 
I have had no bleeding issues with warfarin.
I agree with Cooker.....including several cuts that required stitches, nose bleeds, hard falls, etc, etc.

From what my docs tell me, bleeding is more of a issue with the elderly on warfarin....and due mostly to mismanagement and neglect......and almost ALL of these folks do not have mechanical valves.

BTW, I don't consider 78 elderly LOL.
 
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I fell off my mountain bike yesterday going too fast through a slippery corner and landed on my knee. I had a bleeding event - by the time I got back to the car blood had dripped all the way down my leg. I repaired it by wiping the blood off with an old towel, then went and had a coffee.

It was OK. ;-)
 
I fell off my mountain bike yesterday going too fast through a slippery corner and landed on my knee.
Does this mean you're no longer practicing on that spunky new road bike? You can post it to me over on the east coast if your not using it ... much safer than MTB, normally you just get killed outright by a car or a bus :)

then went and had a coffee.

It was OK. ;-)

Well that's what my friends say about the coffee in WA ;-)

Instagram the towel, post it here. Be good for morale ... pics or its not real as the kiddies say :)
 
Other than the normal shaving nicks and skinned knuckles from working on my car, I've only had one "bleeding event" in the past 13 years. I had a polyectomy during a colonoscopy and the doctor did a poor job of cauterizing the base. It started bleeding about six hours later and my wife took me to the ER. The bleeding pretty much stopped on its own after a couple of hours, but I ended up in the hospital for three days to "prep" for a second colonscopy with a different doc repairing the damage.
I found out after the fact that my original gastro doc had a history of lawsuits from botched procedures which had been settled by his malpractice insurer. He quietly retired about a year later.
Mark
 
I guess my brain bleed was an event! I didn't even know it was happening,(I had only had a major headache the night before) but the CT doesn't lie. My INR was about 9, but this was not caused by my ineptness with my testing, or dosing, but I was going into DIC from acute bacterial endocarditis. What did they do about it? Gave me 2or 3, (can't remember) vitamin K shots in the ER, and continued to stop my warfarin for the next few days. They felt the bleed was more worrisome than the possibility of a stroke from my valve in the aortic position.
My next event I suppose was my latest surgery on my shin, that didn't want to stop bleeding, but it certainly wasn't life threatening. I tried to keep my INR closer to 2, but it didn't seem to do much and it was hard to keep it continually low. It finally stopped bleeding and healed and now it looks pretty scary big, but good.
 
I was bit by my dog quite severely. Nobody, me or the doctor, worred about a "bleeding event." We did worry, just a little, about endocarditis due to infection...my hand wrist and forearm swelled up.

From what I've read about "bleeding events" related to warfarin, they are hard to prove. If you are in a car wreck and die from a blood clot on the brain, the researchers blame this on warfarin. You might have died anyway.
 

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