AW: [HSF] Warfarin for rings

[Rwmfglycar at aol.com]

In a message dated 5/3/2008 12:32:45 P.M. Eastern Daylight Time,  
DukeB60 at aol.com writes:

Will the  St. Jude ANSWER registry address this question re: the  actual  
practice of anticoagulation vs. not in biological valve vs  mechanical  valve?




Ed,
Since I never used coumadin for bioprostheses, followed my patients very  
carefully and even published
 my criteria for calling  an  event a cebral ischemic  episode, I would not 
use it for rings. Thrombus forms on  all synthetic  materials within  minutes 
of implantation. It builds up where stasis is  present. If it is not securely 
attached to the point of build up it can break  away.
I have to say that whereas I was content that my policy worked for  
bioprosthetic valves I did not use rings and therefor my bias is based on  analogy not 
experience.
Because of the rheologic factors in thrombus formation I can postulate a  
situation in which a thrombus might form on a ring.but would expect it to be  
very rare.
At this stage studies of reduced or no coumadin on mechanical valves  do 
continue to use antiplatelet agents
Bob



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