AW: [HSF] Warfarin for rings

[Michael Firstenberg]

to the good dr frater.
you have just violated hsf rule #1 - quoting your own papers without
providing the reference so that we can look it up.  i never put rings
or tissue valves on coumadin unlike some of my partners and am always
looking for data rather than opinions to support my practice.

On 5/3/08, Rwmfglycar at aol.com <Rwmfglycar at aol.com> wrote:
>
> 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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