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Which anticoagulant is best after valve replacement?

Q: I have undergone surgery for VSD/AVR three years back. Thereafter, during a routine echo it was found that the pressure gradient was high and the valve had clotted and thrombosed. I suffered a heart attack and weakness on the left side which has mostly recovered. Three months back, for a short while (about 30 secs), I had a TIA but the CT scan was normal. The neurologist has advised me to discontinue Persantin which I am told has a tendency to separate platelets and can sometimes cause TIA. I am on St. Judes mechanical valve and take Acitrom regularly maintaining a PT of around 2.8 to 3.5. I am not sure if I should discontinue Persantin as all cardiologists have prescribed it. But the surgeon who operated me is of the opinion that only Actirom would suffice. Please advise.

A:I have gone through your history and details. The anticoagulation which is required after valve replacement is in the form of Acitrom or Warfarin. Persantin is added only when there is a thrombosis or embolisation. Now from your description, it is not clear the present status of your valve whether thrombus is still there or not. If your valve is functioning normally and there are no clots and thrombosis then discontinuing Persantin will not harm. Acitrom should be sufficient for anticoagulation. Still you should consult your neurologist and if he insists so, then you can discontinue the Persantin. You should be in regular contact with your cardiologist.

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