Tissue valves and increased risk of blood clots without Warfarin?

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MethodAir

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it's bound to be unsettling for people with bioprosthetic aortic valves, ones made from cow, pig or human tissue. They have become more popular than mechanical ones made from synthetic materials because they don't require lifelong use of blood thinners to prevent blood clots. Few valve recipients were on blood thinners, but those taking warfarin, sold as Coumadin and other brands, seemed protected from the problem, and warfarin also successfully treated it.
http://www.ctvnews.ca/health/doctors-discover-potential-problem-with-implanted-heart-valves-1.2596071
 

pellicle

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Thanks for the link. I've read this from time to time and mentioned it here from time to time in discussions about "I choose X to avoid warfarin"

The Surgeon at the Mayo raises this point with a case in that presentation too.
:)
 

ottagal

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Fundy;n859007 said:
I wonder why this was released as news again. Are they saying that studies done since June differ from those before June?

It relates to the St Jude Portico trial halting back in September of last year. Which was cleared and restarted this June.
http://www.ptca.org/news/2015/0603_STJUDE_PORTICO.html

Thanks for finding this Fundy! When I first read the article, it seemed a little misleading. At first I I thought it was discussing ALL tissue valve implants, including those from standard OHS, but then realized it was a specific a TAVR....as you mentioned, the St. Jude Portico.

I guess the way they wrote the 'article' makes it more sensational and 'newsworthy' and misleading!

Also, thanks for bringing it to our attention, MethodAir.
 

Fundy

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Although it was studied mainly concerning the Portico observation, it does include other valves, mostly TAVR types, but also a few surgical implanted tissue valves.


Surgical valves
–
no. (%)
2/27 (7.4)
Edwards Perimount
1/11 (9.1)
Perimount Magna
1/9 (11.1)
Trifecta
0/3 (0)
Mitroflow
0/1 (0)
Perceval
0/2 (0)

They are listed in the supplementary appendix to the nejm article
http://www.nejm.org/doi/suppl/10.105...3_appendix.pdf

It seems to mention that the leaflet mobility is returned to normal after treated with warfarin, it doesn't mention any findings if the condition seems to return after warfarin is stopped.
 

jumpy

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As far as statistics go the sample size seems to be too small to really make any real conclusions of risk. I'm wondering why they would publish in the journal without first expanding this into a broader population of tissue valve recipients.
 

Paleowoman

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TAVR valves are known to have a high risk of stroke, that would seem to be becuase they don't remove the calcification on the 'old' valve which is beneath the stent.

If the leaflets on the replacement valve are not working properly that would show up on echo. I've had several post AVR echos which check the function of my tissue valve.
 

pellicle

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Hi

Not to disagree with you but I wanted to make two points.

Magazines and other publications like that are NOT journals. One needs to be careful to use the term journal distinctly from other publications. The key reason is trustworthiness of reporting. I work for a university and I'm involved with trying to educate students in sources of trustworthy information.

http://www.angelo.edu/services/library/handouts/peerrev.php

without peer review they can publish any opinions they wish to.

jumpy;n859018 said:
As far as statistics go the sample size seems to be too small to really make any real conclusions of risk. I'm wondering why they would publish in the journal without first expanding this into a broader population of tissue valve recipients.
Secondly you'll be stunned just how often stuff is statistically insignificand and untransferrable.
 

MethodAir

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pellicle;n859006 said:
Thanks for the link. I've read this from time to time and mentioned it here from time to time in discussions about "I choose X to avoid warfarin"

The Surgeon at the Mayo raises this point with a case in that presentation too.
:)

Yes, I recall you mentioning that. There was a post from someone here recently who described how a leaflet on his tissue valve 'snapped'...perhaps Warfarin could add longevity to a tissue valve?
 

pellicle

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Hi

MethodAir;n859027 said:
. There was a post from someone here recently who described how a leaflet on his tissue valve 'snapped'...perhaps Warfarin could add longevity to a tissue valve?
Just based on what I know I wouldn't think warfarin would play any role in preventing that. Unless it was caused by thrombus. My guess there is calcification contributing towards mechanical failure. Keep bending a bit of something that has a crease in it and it will fail at the crease, that's why we use hinges on things like doors (and also as found in mechanical valves).

Anyway I don't think that that study reflects anything like the majority (or we'd have heard more about it by now I feel) but something to be aware of. My gut feeling is that perhaps 5% and increasing towards end of life with the tissue valve.

It occurs to me that the medical groups love tissue for another reason: increased need for monitoring.
 
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