[HSF] Anticoagulation after mitral repair
Prasanna Simha M
prasannasimha at gmail.com
Fri Mar 21 08:55:51 EDT 2008
That is so but many of us dont with better results. That is for the
cardiologists and not for the surgeons :)
Prasanna
On Fri, Mar 21, 2008 at 7:30 AM, Michael Firstenberg <msfirst at gmail.com> wrote:
> but ACC/AHA guidelines from the Cardiologists say coumadin.
>
> -michael
>
>
>
>
> On 3/20/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
> >
> > Nope
> > Still only Aspirin.
> > Prasanna
> >
> > On Fri, Mar 21, 2008 at 2:10 AM, Michael Firstenberg <msfirst at gmail.com>
> > wrote:
> > > so in the past 1-2 years has the answer changed?
> > >
> > > -michael
> > >
> > >
> > >
> > >
> > >
> > > On 3/20/08, Tea Acuff <tacuff at swbell.net> wrote:
> > > >
> > > > I am not a technophile. Maybe Ed is still in mourning. Anyway (at my
> > age?)
> > > > anything that happened more than 2 weeks ago is open for brand new
> > > > experience.
> > > >
> > > > tea
> > > >
> > > >
> > > >
> > > > ----- Original Message ----
> > > > From: Prasanna Simha M <prasannasimha at gmail.com>
> > > > To: OpenHeart-L at lists.hsforum.com
> > > > Sent: Thursday, March 20, 2008 3:12:19 AM
> > > > Subject: Re: [HSF] Anticoagulation after mitral repair
> > > >
> > > > Tea I was saying that you have replied to an email posted by Ed
> > Bender in
> > > > 2006.
> > > > Prasanna
> > > >
> > > > On Thu, Mar 20, 2008 at 9:19 AM, Tea Acuff <tacuff at swbell.net> wrote:
> > > > > Surely you can show us, Prasanna, so I can give proper credit.
> > > > >
> > > > > tea
> > > > >
> > > > >
> > > > >
> > > > >
> > > > > ----- Original Message ----
> > > > > From: Prasanna Simha M <prasannasimha at gmail.com>
> > > > > To: OpenHeart-L at lists.hsforum.com
> > > > >
> > > > >
> > > > > Sent: Wednesday, March 19, 2008 9:55:07 PM
> > > > > Subject: Re: [HSF] Anticoagulation after mitral repair
> > > > >
> > > > > This was a reply to an email nearly 2 years ago !!
> > > > > Prasanna
> > > > >
> > > > > On Thu, Mar 20, 2008 at 8:01 AM, Tea Acuff <tacuff at swbell.net>
> > wrote:
> > > > > > "Should I toss umpteen years of
> > > > > > >practice protocol out the window for this type of result?"
> > > > > >
> > > > > > Only if you envision a different and better world.
> > > > > >
> > > > > > "Are there analogies in other
> > > > > > >human endeavors that can help light the way to truth?"
> > > > > >
> > > > > > Ever talked with someone that lost a child?
> > > > > >
> > > > > > Sorry for your loss.
> > > > > >
> > > > > > tea
> > > > > >
> > > > > > ----- Original Message ----
> > > > > > From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
> > > > > > To: OpenHeart-L at lists.hsforum.com
> > > > > > Sent: Friday, May 26, 2006 2:15:56 PM
> > > > > > Subject: Re: [HSF] Anticoagulation after mitral repair
> > > > > >
> > > > > > >Last week I did a mitral repair on a 73 year old male. He had
> > LVEF
> > > > > > >70%, normal sinus rhythm, no coronary disease, normal or
> > slightly
> > > > > > >elevated PA pressures. I performed a quadarangular resection
> > of a
> > > > > > >P2 flail, a classic plication of the posterior annulus and
> > > > placement
> > > > > > >of a CG future band. No MR or complications post op. No
> > a-fib or
> > > > > > >other arrhythmias. On post-op day 5, I was sitting and
> > talking to
> > > > > > >him about discharge instructions and his medications when
> > right
> > > > > > >before my eyes he has a huge right hemispheric CVA. Two
> > minutes
> > > > > > >previously he was talking normally, and suddenly he has dense
> > left
> > > > > > >hemiplegia with difficult to understand speech. Normal
> > carotid
> > > > > > >arteries and immediate echo shows no thrombus and no MR with
> > good
> > > > EF
> > > > > > >and sinus rhythm. I did use one pledgeted stitch for the
> > annulus.
> > > > > > >I have not been anticoagulating these types of patients
> > post-op and
> > > > > > >have never had a CVA in this type of patient either. Should
> > these
> > > > > > >folks be anticoagulated for a period of time
> > > > post-op? Incidentally,
> > > > > > >one of my partners (whose routine it is to anticoagulate for 6
> > > > weeks
> > > > > > >after mitral repair) had a patient with an INR of 2 on
> > Coumadin
> > > > have
> > > > > > >a MASSIVE retroperitoneal bleed on post-op day 4.
> > > > > > >
> > > > > > >Is there a right or wrong approach. Should I toss umpteen
> > years of
> > > > > > >practice protocol out the window for this type of result? I
> > know
> > > > we
> > > > > > >have had this type of discussion before, but how should one
> > case
> > > > > > >influence a previous body of work? Are there analogies in
> > other
> > > > > > >human endeavors that can help light the way to truth?
> > > > > > >
> > > > > > >Signed a very frustrated
> > > > > > >Ed Bender, MD
> > > > > > >_______________________________________________
> > > > > > Every thing we do has a risk and a benefit. We quote
> > mortalities of
> > > > > > <1% but that means that somewhere along the line 1 in say 200
> > will
> > > > > > die for no apparent cause. We will agonise over what we have
> > done
> > > > and
> > > > > > come up with maybe some suggestions. The same applies to
> > stroke,
> > > > > > renal failure, GI Bleeds etc. At the STS Eric Jamieson reported
> > on
> > > > > > anticoagulation in AVR (IMHO not too dissimilar a situation). I
> > try
> > > > > > and avoid warfarin as I see more complications related to that
> > than
> > > > > > to not using it. It will be perhaps easier in a year or 2 when
> > some
> > > > > > of the newer oral agents (Factor Xa inhibitors oral once daily)
> > or
> > > > > > direct thrombin inhibitors become available. Xemilgatran
> > > > > > unfortunately was a fizzer.
> > > > > > I do not anticoagulate AVRs or MV repairs with warfarin. ASA
> > alone.
> > > > > > There is no evidence to support the addition of clopidogrel
> > unless
> > > > > > there is aspirin resistance, and I would suggest that the risks
> > of
> > > > > > using it would be higher than not.
> > > > > > --
> > > > > > Ben Bidstrup FRACS FRCSEd FEBCTS
> > > > > > Consultant Cardiothoracic Surgeon
> > > > > > _______________________________________________
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> > > > > --
> > > > > Prasanna Simha M
> > > > > _______________________________________________
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> > > > --
> > > > Prasanna Simha M
> > > > _______________________________________________
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> > --
> > Prasanna Simha M
> > _______________________________________________
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--
Prasanna Simha M
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