My Meds: Warfarin & Metoprolol

ARC_Talk_About_Meds_Banner_Anthony

Hey cool banner huh?! The folks over at The Recall Center asked me to post about the medications that I’m on and how they effect my life. This is an important topic and I actually haven’t taken the time to write about it yet. I will review my diagnosis, surgical history, and the medications that I’ve been on within the past year.

My original diagnosis is that I was born with a congenital heart defect called bicuspid aortic valve. A normal aortic valve has three leaflets that open and close to let blood out of the heart, while I was born with a valve with only two leaflets. This condition is also associated with a compromised ascending aorta, which forms an aneurysm.

My valve was originally replaced on November 25th, 2013 with an On-X mechanical valve. I had a major complication only three months after that; infective endocarditis of the prosthetic valve, which led to a prompt, emergency re-do of the same operation. They implanted a St. Jude’s mechanical valve the second time.

The long term medications after each surgery were similar. I was placed on Metoprolol (50 mg), a beta blocker to keep the heart rate and blood pressure low. It controls the heart rate by binding to beta receptor nerve cells in the heart muscle, which blocks these cells from binding to adrenaline, epinephrine, and other stress hormones that can increase the heart rate. Basically, it keeps you chill all the time.  Usually the heart rate goes up for a while after heart surgery. Previous to surgery, I had a resting heart rate of 65 BPM. After surgery, even while on Metoprolol, My resting rate was 85-100 BPM for about six weeks. As my heart healed, my heart rate went down, which was a good sign. After that six week period, I started to get tired of this drug. It caused dizziness when I stood up too fast. It did not allow my heart rate to get above 130 BPM once I started riding my bike again. I felt that it was holding me back. I felt sluggish. I stayed on Metoprolol until four months after my second heart surgery. Cardiologists often disagree about whether prosthetic heart valve patients can discontinue Metoprolol. My current cardiologist explained that this drug is often prescribed after heart surgery, but in his opinion after the heart heals and there are no arrhythmia problems, then the beta blocker COULD be discontinued. My doctor gave me permission to slowly phase myself off of this med as discontinuing it cold turkey can cause  tachycardia or other uncomfortable/ dangerous issues. I decided to go off of this drug when my resting heart rate settled to 55-59 BPM, which technically speaking is brachycardia, or a slow heart rate. Since then, I’ve been feeling great with a resting rate of 65-75 BPM.

NEVER discontinue your medication without first consulting your doctor!

I was also placed on Warfarin (generic of Coumadin) with a target INR range of 2.0-3.0. Warfarin is commonly referred to as an blood thinner, though it is actually an anticoagulant. Patients with a mechanical valve must take an anticoagulant to prevent blood clotting on the valve. This clotting is called thrombosis, and is deadly as it can dislodge and cause a stroke elsewhere in the body. Once a month I go to the lab at my cardiologist’s office to get my blood tested. If I am not hitting my target range, then they adjust my dose. With a mechanical valve, there is no way around this med. I must take it or else I am seriously at risk. Taking anticoagulants, however often come with their own risks associated with bleeding. I have to be careful with my diet. Foods that are high in vitamin K, like leafy greens such as spinach or kale, can lower my clotting levels (INR). Other factors such as activity level and alcohol can effect a patient’s INR. To be honest, I live my life similarly to pre-surgery levels. I eat a well balanced diet with plenty of leafy greens, I am very active (cycling, rock climbing, lifting), and I have a few drinks each week. My Warfarin dose has been adjusted so that I hit my target INR without changing my lifestyle. People have problems with staying in their range when they make drastic changes all of a sudden to their diet, binge drinking, forget doses, etc. Often when a patient comes back from a vacation, their levels are off. Being a rock climber, cyclist, adventurer, I am at a legitimate risk of having a dangerous bleeding even while on this medication. A head trauma can be deadly. I have chosen to accept these risks in a pragmatic, responsible way by continuing my sports, but always wearing my helmet not participating in reckless behavior. Be sure you make these decisions along with your family and doctor.

I also take one baby Aspirin daily. This is taken for anticoagulant reasons as well. Studies have shown that mechanical valve patients are less likely to have thrombosis when they take aspirin in addition to Warfarin.

There are various anticoagulants each tailored to different types of conditions. There are some new drugs that have come out to treat people with different heart conditions, like atrial fibrillation , and who do not have artificial heart valves. Some of these drugs are appealing because they may not require monitoring of anticoagulant levels. The Recall Center recently posted about a series of lawsuits against one such drug called Xarelto. It appears that this drug may have some increased bleeding risks that may not outweigh the benefits of forgoing monthly monitoring testing that goes along with drugs like Warfarin. Also, Warfarin can be counteracted with high doses of vitamin K in case a patient needs emergency surgery (this happened to me), while Xarelto does not have an ‘antidote’. Do your own research before taking any new drug. You can learn more about Xarelto by clicking here.

How do I remember to take my medications?

Pill_BoxAfter my first surgery, I set a medication alarm on my iPhone. Studies have shown that patients who have some sort of reminder increases medication adherence, thus increasing their chances of a healthy recovery. I also always use my weekly pill reminder box. This pill case has morning spot and an afternoon spot for each day. I’ve gotten into the habit of every sunday, I refill the entire box with a week’s worth of meds, so all I have to do is take my dose when I wake up and go to bed each day.

Remember:

  • Ask your doctor why you are taking a medication.
  • Ask your doctor how the med works, and its side effects.
  • Ask your doctor if there are lifestyle changes that you can make instead of taking the medication. For example, you might be able to lower your blood pressure by changing you activity levels and diet.
  • Set up a reminder system that might involve alarms, calenders, and pill boxes. Consistency is important with any med.
  • Inform your family about your medications in case of an emergency.
  • Ask your doctor questions, and write down your doctor’s responses! I record every conversation that I have with my doctor on my iPhone’s audio recorder.

5 thoughts on “My Meds: Warfarin & Metoprolol

  1. Rick Holstein

    Looks like we’re a lot alike–I raced bicycles for 20+ years and like you, found late in life I had a bicuspid aortic valve and had it replaced with a St. Jude mechanical valve in 2012 at age 50. I am also on warfarin and metoprolol (50 mg/day) and will probably stay on the metoprolol due to help control the PVCs I had before (and after) surgery. Pre-surgery, I had a freakishly high max heart rate of close to 200 BPM (and I’m a big guy–6’5″ and 205 at the time). I’ve done experiments, on on the same ride at the same pace, the metoprolol can make a 30 bpm difference! I don’t try or train for max heart rate anymore, so I have no clue where that is. The one time I tried it (about 8 months after surgery) my heart kicked into Afib for about 12 hours, so I’m done with any type of high intensity training or racing. Other long term effects are weight gain, but I’m not sure how much of that is on me and how much I can attribute to the metoprolol.

    Reply
  2. Jason Larsen

    I enjoyed this and it’s nice to relate to someone similar to me. I’m 35 and was a firefighter prior to my diagnosis. I’m curious about your INR levels. My surgeon has me on 81mg of ASA and a INR of 1.5-2.5 using a st jude valve. So far I’ve been 1.7-8 three weeks post surgery.

    Thank you again for sharing

    Jason

    Reply
    1. Hilary Lamothe

      Hi Jason, My wife had a St. Jude Mitral valve (disc type) installed 28 years ago. A doctor (nearby hospital lab) mis-advised her INR level to be NORMAL when it needed to be 2.5 to 3.5. She was exercising in the pool and had a stroke that we found 25 years later, had blocked one carotoid artery in her neck! The range you listed seems way too thick! I am reading your link because I had the same excellent surgeon Dr. Douglas Murphy at St. Joseph’s Atlanta GA do robotic surgery/full repair of my Mitral valve (on a system he has been working to develop 14 yrs) back on Dec 28. I was able to drive Jan 4th, and back to work Jan 19th. I did do the recommended Cardiac Rehab monitored exercise program for 6 of the recommended 12 weeks, and was released to exercise alone by my cardiologist.

      Reply
  3. John O'Neill

    Hi Anthony
    I am a 63 year old Minnesota farmer. Six years ago this month I passed out after a 5k race In Spicer MN. It was a balmy 26 degrees below zero that day but I knew it wasn’t the cold because I always ran in the cold. By the time I got an appointment with my local Dr. It was the end of March and he said I now had a heart murmur, which I had never had before in my 32 years of physicals with him. I went home and called the Mayo Clinic and got an appointment the next Monday morning. Mayo informed me I had a Bicuspid aortic valve and a 5.3 cm aneurism and needed one bypass. I met with Dr Schaff and after telling him I was a 185 lb. runner and triathlete who used to weigh almost 300 lbs 9 years ago,he said I would wear out an animal valve too fast so I would need a mechanical valve. This would mean a life on coumiden. He also suggested I get my own machine to check my own INR weekly. The insurance company had no problem with it. I have had a coumiden clinic that cooperates in setting my dosage high enough to allow me to eat my leafy green vegetables. I have had my challenges with bridging for biopsies and now robotic prostatectomy for prostate cancer. I have had an interaction between Lovonox and coumiden that has caused hemorrhaging and blood clots. Each time they have done the bridging a little different to get away from these problems. As much as I understand the corelation of exercise, diet and dosage it is still a challenge to get back to a consistent range after bridging.
    I started cardiac rehab a week after heart surgery. I walked a 5k 30 days after surgery and jogged a 4 mile race 60 days after and ran a 5 mile race 90 days after. At my 6 month checkup I asked my cardiologist if I could run a first ever marathon? He answered that I now had a better heart than ever before so there was no reason I couldn’t run a marathon. Thirteen months after open heart I ran my first marathon Grandmas in Duluth in 4:15:20. I usually run about 12 races a year and 3 or 4 triathlons every year. I am also thinking of a full ironman to celebrate successful cancer surgery. My Mayo Dr. Keeps saying if I wasn’t a runner they never would of met me. They also say how good surgeries go on physically fit patients.
    Keep living a full life!

    John O’Neill

    Reply

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