Over the years, I have seen many patients with an artificial heart valve. Many of those people take the prescription blood thinner warfarin (Coumadin) to prevent blood clots, especially if they have a mechanical heart valve. These days, I get asked if there is an alternative to warfarin if you have a mechanical heart valve.
Sadly, as of late 2017, there is not a safe option.
The heart has 4 valves: aortic, mitral, pulmonic, and tricuspid. The valve opens to let blood through and closes to prevent blood from leaking backward. In some people, the valve may be diseased and limit blood flow through the valve. This is called stenosis. In some people, the valve may leak, allowing blood to flow backward. This is call regurgitation, or the valve is classified as insufficient.
Most commonly, people have either aortic valve stenosis, aortic valve regurgitation, or mitral valve regurgitation. Check out this blog for how to prevent valve disease.
Valves can be replaced or, in the case of the mitral valve, repaired. Replacement is usually with either an animal tissue valve or a human tissue valve. Sometimes, a mechanical heart valve is used.
The mechanical heart valve is more durable and can last a very long time. The downside is lifelong anticoagulation (blood thinner such as warfarin/Coumadin) and the valve makes a click noise that can irritate the patient or someone close to the patient: sleep disturbance for example.
The tissue valve does not make noise and does not require a blood thinner. The downside is that the valve does not last as long, typically 8 to 10 years. ( With me as the cardiologist, I think the tissue valve can last forever).
The risk of clotting the mechanical valve leading to valve obstruction, stroke, or peripheral embolism is WAY too high: 20-50% clot per YEAR!
The only drug recommended for anticoagulation with a mechanical heart valve is warfarin/Coumadin. Aspirin will not help.
There is a new group of drugs such as dabigatran, rivaroxiban, and apixaban that are heavy-duty blood thinners. The advantage of this group over warfarin is that blood levels do not have to be monitored and there is no interaction with food. Thousands of people take this class of drugs for clot prevention with atrial fibrillation.
Only one study has been released on dabigatran versus warfarin in people with mechanical heart valves. The study was stopped early because of increased clotting events in the dabigatran group. Can’t use it for this indication. Atrial fibrillation yes, mechanical heart valve no. Excellent review of the science data here.
You may have read my previous post on nattokinase. It is a great supplement for a variety of health conditions. Unfortunately, I cannot recommend this supplement for people with a mechanical heart valve. The risk of clot is too high and there is ZERO literature to support nattokinase in this condition. Other “natural” blood thinners include vitamin C, vitamin E, omega-3 fish oil, and garlic. They are all great and may be helpful in many people. Still, no combination of these along with nattokinase can be recommended at this time.
Most of you know, I am the most likely cardiologist in the world to recommend natural treatments for my patients. This situation is too risky. I treat my patients like family members. I could not recommend natural OR one of the new drugs at this time.
Hopefully, another study will figure out another option, either natural or with pharmaceutical.
Until then, you are stuck with warfarin. The key to warfarin is consistency in your diet. Patients have been told to avoid vitamin K containing foods because it interferes with warfarin activity. That is horrible advice. Seriously, cardiologists would rather these people eat cheese crackers and Frosted Flakes than an kale salad.
I tell my patients to eat veggies every day and all day. You will get all the benefit from the food, just not the benefits from vitamin K. The dose of warfarin can be adjusted.
Lack of vitamin K function is a problem, but it is a necessary trade off for those with a mechanical heart valve.
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