colonoscopy-aortic versus mitral valve

[mile high]

The colonoscopy questions and incidents seem quite pervasive. The questions of coumadin or not, lovenox or not, how long not to take coumadin arise quite frequently.

My question is, is there a difference in risk of stopping coumadin for a few days for those that have artificial mitral valves versus those with artificial aortic valves. The risk I refer to is a stroke.

I believe that there is much greater force of blood flow thru the aortic valve. This may lead to a lesser risk of a clot than someone with a mitral valve.

Should there be a different regimen of coumadin/lovenox or lack thereof, for those with artificial aortic valves versus those with artificial mitral valves?

Mile High

 

[tommy]

Yes, there is a difference in risk between mitral and aortic mechanical valves when having a colonoscopy. Check out this link for the ASGE guildines. The mitral position is considered high risk condition and the aortic position is considered low risk condition. The risk level for the procedure depends on whether you have polyps removed.

http://www.asge.org/nspages/practice/patientcare/anticoagulation.cfm#PageLink05

For what it's worth, even though my aortic in considered low risk, my cardio treats me in the high risk category anyway.

 

[warrenr]

colonoscopy

colonoscopy

Mile High,

According the the ASGE there is no need to stop coumadin for a colonoscopy with or without biopsy regardless of the underlying condition risk. i.e. valve position. Colonoscopy is a low risk bleed procedure with or without biopsy.

Procedure risks
Endoscopic procedures vary in their potential to produce significant or uncontrolled bleeding. Low-risk procedures include diagnostic esophagogastroduodenoscopy (EGD), flexible sigmoidoscopy and colonoscopy with or without biopsy, diagnostic endoscopic retrograde cholangiopancreatography (ERCP), and biliary stent insertion without endoscopic sphincterotomy, endosonography (EUS), and push enteroscopy.

Recommendations

Low-risk procedures: No adjustments in anticoagulation need be made irrespective of the underlying condition. However, elective procedures should be avoided when the level of anticoagulation is above the therapeutic range.

 

[tommy]

Mile High,

A polypectomy is considered high risk procesure. In a high risk procedure, the treatment is different depending on whether your condition is high risk(mech mitral) or low risk (mech aortic).

Frankly, even with an aortic valve, my cardio and I also use the high risk treatment. Why not? To be off Coumadin for 4-6 days is the most risk and the most unecessary thing that we can do.

So, you can opt for a diagnostic colonscopy without change in Coumadin dose. You may have to work to find a doctor to do it. If he finds a polyp, you may have to come back a week later to have it (them) removed.

For what it's worth, for my first colonscopy, I decided to expect one or more polyps and do this once. I was right. But that does not make it right for all. Others may say that I took unnecessary risk. I respect that opinion.

I am doing the same Lovenox bridge this time because I expect the surgeon to be "agressive" in finding the site to biopsy. The "activity" may be invisible (inside the bowel wall), and he may have to do some "digging". The whole point of this procedure is to find out what the activity is. I don't want the surgeon to hold back. I want him to find it. If he does not find it through the back door, another surgeon will go after it through the front door. Lovely metaphors, huh? So even though this "colonoscopy with or without biospy" appears in the low risk category, we are treating that as a high risk procedure.

PS........for the first colonoscopy, the GE surgeon hot cauterized each polyp (4 of them) and did not move on until he was sure the bleeding had stopped.

Does this make things clearer or muddier?