Warfarin Institute of America
Dedicated To Your Health
Mechanical Valve Replacement: A Lifetime of Warfarin
By
Tanya Suvarnasorn, PharmD Candidate
University of Colorado Health Sciences Center
School of Pharmacy
Patients undergoing valve replacement surgery need to take anticoagulants or “blood thinners” following surgery to avoid complications from the formation of clots such as a stroke. For those receiving mechanical valves, warfarin becomes a permanent part of their medication regimen. Patients opting for a tissue valve are at risk for a clot formation within the first 3 months after surgery, and may only be on warfarin for a few months. Tissue valves are less durable than mechanical valves, and there is consequently a higher risk of future surgeries. Some patients choose to take that risk to avoid lifetime anticoagulation therapy, while others opt for the more durable mechanical valve.
Recently, I was fortunate enough to meet with several members from valvereplacement.com at their annual meeting in Golden, Colorado. I interviewed several of them regarding their experiences with warfarin and their initial fears about beginning anticoagulation therapy. All of the patients that I interviewed have had a mechanical valve placed and are on lifelong warfarin therapy.
DAVE
Dave had a congenital defect resulting in aortic stenosis with a bicuspid aortic valve. He underwent surgery in April 2003 to replace his aortic valve with a St. Jude mechanical valve and repair an aneurysm with a Dacron sleeve.
His biggest fear about starting warfarin was regarding the frequent blood tests – he hated needles. However, since May 2004, he has been able to self test at home and calls his results into an anticoagulation clinic about once a month. He is able to maintain his INR within range using 5 to 7.5mg of warfarin daily.
When he initially started warfarin, he did not know much about the medication or the implications of taking it. He had heard that people on warfarin tend to bruise easily and that they had to be careful to avoid head injuries. Since then, he has not experienced any side effects from the medication. He doesn’t notice any bruising, and says that if he cuts himself shaving, it doesn’t bleed any more than it did before.
Dave has not experienced any problems keeping his INR within range and advises anyone who is going to be starting warfarin to “find out as much as you can from as many different sources as possible.”
JENNIFER*
When Jennifer was told that she was going to be on warfarin after replacing her mitral valve with a mechanical valve, she was concerned about the impact it would have on her diet. She loved vegetables and was afraid that she would have to stop eating them entirely due to the interaction of certain vegetables with warfarin. Fortunately, she knew an anticoagulation nurse who was able to reassure her and inform her that she did not have to stop eating vegetables. She was told that it was important not to “yo-yo” and eat lots of vegetables one week, then none the next. She currently eats 2 salads a day without any significant problems.
Although she does bruise easily, she attributes this more to being a klutz than the warfarin. She believes that other people are more concerned about her cutting herself and bleeding than she is. Jennifer feels that preventing a stroke is far more important than the risk of bleeding.
The one side effect that she has noticed is intolerance of cold weather. She notices that she is more sensitive to cold than her co-workers or family and occasionally has difficulty warming up.
She does not consider her warfarin therapy a very big deal, although she is more conscious of what she eats. She home tests approximately once a week and maintains her INR within range using about 6 mg of warfarin per day.
STEVE*
Steve underwent surgery in April 2002 to replace his aortic valve with a St. Judes Mechanical valve and to replace his ascending aorta with a Dacron tube. He did a lot of research on the surgery and on warfarin, so he did not have any fears about starting anticoagulation therapy.
He checks his INR every 1 to 6 weeks, depending on the results and takes 7.5 to 10 mg of warfarin a day to keep his INR within range. He said that he has not had any problems due to warfarin, but notices that his INR occasionally goes really high when he drinks a lot. He said, “It’s all about a constant diet. It doesn’t matter what you eat or drink as long as it’s constant.”
Steve also mentioned that he became depressed after surgery and was concerned because it is not something that is discussed. He said that it was fairly common, especially for men, to become depressed following heart surgery and was surprised that more people are not talking about it. He now takes Paxil®, which he feels has helped incredibly and brought him back to where he was.
HANK EYRING
Hank Eyring had his aortic valve replaced with a St. Jude Mechanical valve in April 1999. He was a respiratory therapist, and had some prior knowledge of warfarin, so was not anxious about starting the medication. He now takes 5 to 7.5mg of warfarin per day and home tests about once a month. When he first started on warfarin, he tested 2 to 3 times a week, but now that he knows where his values usually fall and how they respond to his diet, he is comfortable testing less frequently. He has not had any side effects from warfarin other than some occasional bruising.
During Hank’s home recovery from surgery, he established email communication with other people going through similar experiences. Since then the emails have developed into a website that serves an information source and support for people who have had valve replacement surgery. His goal was to create a central place that was easy to find for people to get more information. Valvereplacement.com now has over 1100 members, and gains an average of 2 new members each day.
Hank is concerned because he feels that people opt for the risk of a second surgery with tissue replacement rather than hassle with warfarin therapy following replacement with a mechanical valve. He says that people need to realize that warfarin is not that big of a deal. It has not impacted his life, and he has not had to change his diet or activity to accommodate the anticoagulation therapy.
Hank feels that education is important for anyone beginning treatment with warfarin.
MELISSA*
Melissa had her aortic valve replaced with a mechanical valve in October 1999. Prior to the surgery, she was told that she was getting a mechanical valve and that she would have to take a pill for the rest of her life, but she did not know what the pill was or what the ramifications of the pill were. She got some printouts from the hospital that explained about interacting foods, but she had no idea how important it was to be fully educated about warfarin.
When she investigated warfarin on her own she realized the implications of taking warfarin, and felt that some people in the medical profession are not as educated as some of the people belonging to the valvereplacement.com website. She has self-tested since December 1999 and goes to the lab occasionally to compare results. She does not like taking drugs in general and was not happy when she was told that she would have to be on warfarin for the rest of her life, but she says she deals with it. When her INR gets out of range, she gets angry, but she knows how to get it back within range. She says that warfarinfo.com has “been a godsend” and is invaluable.
When she was planning to have a molar extracted, both her dentist and her cardiologist wanted her to stop taking warfarin for 2 to 3 days prior to the procedure, although neither person was confident with the decision. She decided to continue the medication, and found her INR to be 2.4 the morning that she was schedule to have her tooth extracted. She had no problems following the procedure, and took some information from the warfarinfo.com website to her dentist to educate him about warfarin therapy and dental procedures and feels that she and warfarinfo.com have successfully educated one more dentist.
The overwhelming message that I heard from all those that I spoke with was educate yourself. Do the background research. Contact a variety of knowledgeable people and be sure to have all of your questions and fears addressed.
Thank you to all of the members at valvereplacement.com who helped me complete this project.
*Some names have been changed to protect patient confidentiality.
References:
- Rahimtoola SH. Choice of Prosthetic Heart Valve for Adult Patients. J Am Coll Cardiol 2003;41:893-904.
- Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Miller N, Pauker SG. Antithrombotic therapy in valvular heart disease – native and prosthetic: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest September 2004;126:457S-482S.
© 2004 Tanya Suvarnasorn
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Last updated January 1, 2006