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Warfarin

Hi all, This is my first post. I am about to undergo open heart surgery in two weeks and, because the surgeon will be using a mechanical valve rather than a biological one, I will have to spend the remainder of my life taking the blood thinner Warfarin. Now about four months ago I had a colonoscopy because I was suffering from a sudden urgency and frequency to pass stool and, as my mum and brother both have Crohn's while my dad suffered from ulcerated colitis, this rang some alarm bells. Much to my relief there was nothing abnormal and I was told that my worries were unfounded. However they also did a biopsy and I had the results last week. This showed, to quote, 'focal active iletis in the terminal ileum and active chronic proctitis'. And the report indicated that this led them to believe that mild Crohn's is a possibility. To date I have had no bleeding but I do know the Crohn's is a progressive condition and I am very concerned that, at some point in the future, I may encounter a problem with the Warfarin if I start passing blood. I could ask my surgeon to consider using a biological valve but I do know that he wants to avoid this for other good reasons if possible. If I do have Crohn's it has clearly been identified at a very early stage. Assuming that I keep a careful eye on any developments is bleeding something that is unlikely or can be avoided? Any advice would be greatly appreciated.
 
I had open heart surgery a few years back for an AAA and have a BAV, but it wasn’t leaking bad enough to replace at the time of my surgery, so I get checked annually to monitor the leak.
Are you really young? Is that why your surgeon doesn’t want to do a pig/cow valve? I spent a lot of time discussing, researching and thinking about mechanical vs pig given I was only 38 when I had my surgery. I was diagnosed with Crohns after that surgery so didn’t have the info when I originally made the decision, but given they didn’t replace my valve then, like they thought they would have to, I have the benefit of rethinking my decision when the time comes around again. I originally chose mechanical purely because of my age so I didn’t have to continually have repeat surgeries as I aged, but will definitely rethink that decision now as I have had several rounds of random GI bleeding and have been admitted to the hospital twice because of it, and once almost had to get a blood transfusion.
 
Thanks for your reply. My surgeon didn't really discuss his reasons but it's certainly not because of my age. I'm 66, an age where I might expect to have a pig/cow valve replaced once. I think that the reason is that, along with replacing a bicuspid aortic valve, I also have a thoracic aortic aneurysm that needs repairing. The position of the aneurysm means that it can't be worked on while I am on a heart/lung machine and they will have to freeze me to death (The surgeon's description not mine.) while they carry out the work. My guess is that, once done, they do not want to risk operating again for fear of disturbing this repair. I have my pre op later today and I can't make up my mind as to whether I should even mention the Crohn's. I've waited a long time for my surgery, in part due to the coronavirus lockdown, and it has already been cancelled once before. As I mentioned, the symptoms that suggest Crohn's are at a very early stage and I'm hoping that, with careful management, I can avoid any risk of bleeding. Or is that just wishful thinking?
 
Location
San Diego
I have Crohn's and I am also on a blood thinner (Eliquis) due to bouts of atrial fibrilation. Currently, both diseases are in remission thanks to medication - Stelara in the case of the Crohn's. I too worry about suffering a GI bleed due to Crohn's made much worse by the blood thinner. But so far that hasn't happened - primarily because the Crohn's has been kept in check.

So with careful management of your Crohn's to achieve and maintain remission, I think your risk of bleeding due to warfarin therapy should be no greater than it is for a person on warfarin who doesn't have Crohn's.
 
Thanks Scipio, that sounds reassuring. I have heard some scary stories about people needing blood transfusions because of Crohn's coupled with Warfarin but I've no idea how common that is or if, with careful management, it can always be avoided.
 
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