Human blood coagulates come in contact with foreign material, like in with mechanical valve leaflets.  That is why patients with mechanical heart valve prostheses need lifetime anticoagulation therapy to prevent fatal valve blockage due to thrombus formation.  Anticoagulation drugs, so-called blood thinners, are based on a coumadin, a substance that alters the clothing pathway by blocking factor VII synthesis. Several brand names of coumadin drugs exist, like Sintrom, Farin, Marcoumar, Syncoumar, Syncum, etc.

Lifetime anticoagulation therapy is, therefore, necessary in all patients with the mechanical heart valves. Patients with tissue valves or valve repair patients should take anticoagulation pills only for three months after the surgery.  In the case of atrial fibrillation, lifetime anticoagulation therapy is mandatory regardless of the heart valve procedure. Some other, non-cardiac medical conditions also require anticoagulation drugs like deep vein thrombosis, pulmonary embolism, etc.

Patients have to take anticoagulation pills every day, and its therapeutic effect should be maintained between INR values of 2,5 – 3,5. Heart valve patients with INR bellow 2,5 risk valve thrombosis while high INR increases the risk of bleeding. Patients will quickly learn to adjust anticoagulation therapy by themselves. One should keep in mind that every change of coumadin dose will take effect in 2 – 3 days.  Therefore, if you increase the coumadin dose today, INR checks up should be done in two days. Dose adjustment needs to be done gradually as well, by ¼ to ½ of the tablet.

Any difficulties in INR adjustment need to be discussed with your physician. Infection, illness, or surgery could affect INR and make it difficult to maintain within desired values. Green leafy vegetables like cabbage, spinach, lettuce, etc. decrease the anticoagulation effect of coumadin drugs and need to be either avoided or adjusted to the therapy. The same applies to blue sea fish or liver. Drugs like ASA (Aspirin), some antibiotics, amiodarone, omeprazole could increase blood thinning. On the contrary, phenobarbital or some anti-epileptic drugs, contraceptive pills, etc. could increase blood clotting. Anyway, patients  need to check with their physician’s possible side effects of their therapy regarding the anticoagulation