Good video done at the Mayo on self testing and which valve is better

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skeptic49

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This is an excellent (if somewhat dated already) 2010 presentation. The argument seems to be that patients, especially elderly patients, live longer with mechanical valves than with tissue valves. The presenter's assertion that Coumadin will be a thing of the past by 2015 is interesting. Is that happening? Are we in fact moving away from Coumadin toward newer anticoagulants? The emphasis that he puts on self-testing is also noteworthy. For those of us growing older while in the waiting room this video presents significant food for thought.
 
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chaconne

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I, for one, worry about the new anticoagulants since they don't seem to be as easily reversed as Warfarin (need dialysis rather than Vitamin K). I suppose over time some of them will prove to be just as effective or better. These other meds require taking a pill 2 times a day rather than 1.
 

ElectLive

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Well I finally got a chance to watch this presentation, and was thinking to myself that it was generally well thought out, presented, etc. Then the last 30 seconds the sound research and logic just completely got thrown out the window and ruined the whole thing for me... And I quote: "I doubt there's going to be any patients on Coumadin [by 2015]." Wow...

For anyone that takes the time to watch this, I would advise that the last part be completely ignored, it is not accurate. The magic new drug he mentions, dabigatran (more commonly known as Pradaxa), will not be replacing Warfarin anytime soon, nor possibly ever. Here's a brief snapshot of reasons why:

The initial dosing study of dabigatran for those with mechanical valves did not even begin until 2 years after this Mayo presentation and was quickly halted after those on dabigatran were having significantly more (double or higher) stroke and bleeding events than those on warfarin. Even had that dosing study gone in the other direction, it would have then required a full blown randomized trial before even thinking about submitting for FDA approvals, again pending actual good results. So, ballpark guess how long all of this would have taken? Actually, not that hard, maybe around 8 years, since the same drug went through the same process for A-Fib.

More importantly, though, at the time of this presentation, it was not even yet approved for A-Fib. And when it later was, it was very clearly not indicated as clinically better than warfarin, but was only approved by the FDA as non-inferior (also with big bold warnings - Not for those with Valve Problems!).

So anyway, he did a good job of pointing out the bias of other institutions earlier in this presentation, much of which is true. But while there are lots of great reasons to sell patients on mechanical valves, I sure hope he is not, or was not, promising all his prospective mechanical valve patients that they will be off Warfarin by 2015, as he did here. I'm somewhat astonished...not only is this coming from an obviously well qualified surgeon at a top 5 in the US heart center, but he also happens to be the 2012 President of the American Association of Thoracic Surgeons. Yikes...
 

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