[HSF] Anticoagulation after biological valve or repair

[Michael Firstenberg]

sounds like a friendly update call to his cardiologist is in order.
interested to hear the reason.

On 5/3/08, Edward P Raines <dukeb60 at aol.com> wrote:
> After four units of FFP and Vit. K his INR was 1.7.  Took him to the
> OR on 15 mic. of dopa. and prepped and draped prior to induction of
> anesthesia.  Removed 1200 cc of clot and blood with not obvious source
> of bleeding.  Lungs intact again.  Off dpopa near extubation in ICU.
> He is in NSR, EF okay so not sure why he is on coumadin.
>
>
>              Ed
>
> Sent from my iPod
>
> On May 3, 2008, at 1:47 PM, "Michael Firstenberg" <msfirst at gmail.com>
> wrote:
>
> > Rat Poison, I say, rat poison...... good luck!
> > (not to wish this on anyone, but how do you know this is not a leaking
> > pseudo-aneurysm or suture line problem... i.e. reinfection or some
> > other
> > problem)
> >
> > My philosophy is that patients on coumadin or who need coumadin get
> > 1 life
> > threatening bleeding complication then I discuss with them and their
> > families coming off of it (unless they really really need it - like
> > for a
> > mechanical valve - when I was general surgery resident and saw a lot
> > of
> > trauma, I was amazed at how many patients were on coumadin/plavix/
> > both for
> > very vague reasons).  Coumadin for afib is the worse - 6-20% risk of a
> > stroke (minor TIA to death) per year vs. a major bleeding
> > complication (like
> > GI bleeding, scopes, hematomas, etc)..... Most patients after they
> > have a
> > complication will opt for no coumadin.
> >
> >
> > -michael
> >
> >
> > On 5/3/08, DukeB60 at aol.com <DukeB60 at aol.com> wrote:
> >>
> >> I just got a call from the ED and a  cardiologist regarding a post-
> >> op.
> >> third
> >> time redo aortic valve who  presented today with hypotension.  He
> >> had a
> >> previous AVR a few years ago  with subsequent prosthetic
> >> endocarditis and
> >> got a
> >> tissue valve replacement only  to develop a large perivalvular leak
> >> and
> >> subvalvular aneurysm for which I was  consulted.  He has very, very
> >> severe
> >> bullous
> >> emphysema with his lungs  touching in the midline for six inches
> >> before
> >> you could
> >> even get to the heart by  preop CT.  I did his redo, redo AVR a
> >> couple of
> >> weeks
> >> ago and by some  miracle was able to dissect down to the heart and
> >> aorta
> >> without a hint of an air  leak and replaced his valve and repaired a
> >> subvalvular
> >> aneurysm bulging into the  LA due to a disruption of the Aorto-Mitral
> >> continuity.  He remarkably did  very well and was discharged only to
> >> return today with
> >> hypotension and a CT  showing a large mediastinal hematoma causing
> >> tampanode.
> >> Oh by the way, his  INR is 6.  I'm waiting right now to get some FFP
> >> infused
> >> then evacuate the  hematoma and deal with those lungs again.  I'm
> >> not sure
> >> why
> >> he is on  Coumadin.  It only reinforces the points made previously
> >> that
> >> the
> >> morbidity  of the coumadin outweight the risk of CNS events but the
> >> cards
> >> do
> >> love  coumadin.
> >>
> >>
> >>                             Ed
> >>
> >> Edward P. Raines, M.D., J.D.
> >> BryanLGH  Cardiothoracic Surgery
> >> BryanLGH Medical Center East
> >> 1600 South 48th  Str.
> >> Lincoln, Nebraska 68506
> >> Office: 402-481-8430
> >> Cell:  402-730-9242
> >> Fax: 402-481-8429
> >>
> >>
> >>
> >>
> >>
> >> **************Wondering what's for Dinner Tonight? Get new twists on
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> >> favorites at AOL Food.
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