Tuesday, October 07, 2014

Dr. Groucho got it right

Groucho Marx might have said it best: "I intend to live forever, or die trying."

I can connect with Groucho after a hole in my heart was closed back in 2007. Click on this link for info about my patent foramen ovale (PFO) closure and why.

The short story version is that the hole between the upper two chambers in my heart apparently allowed a blood clot to circumvent the clot-filtering mechanism in the lung, leading to a stroke in 1998 and a mini-stroke in 2007.

Since then, I've seen lots of studies indicating that this procedure might or might not be the best way to treat stroke survivors, looking at procedure vs. blood-thinning medication. My concern about warfarin (also known as Coumadin) was that as a fairly active person, taking pills that make you bleed easier might not be a good idea. Plus, pills and the related monthly blood tests cost money. I ditched the pills six months after the procedure.

That's more of a long-term concern instead of the relatively short-term outcomes in most studies. However, a recent study suggests that PFO closure may be cost-effective over long term:
PFO closure reached the incremental cost-effectiveness threshold of  < $50,000 per quality-adjusted life-year (QALY) gained in 2.6 years. Moreover, the treatment met the threshold of < $50,000 per life-year gained in 4.9 years. The per-patient mean cost of medical therapy surpassed that of PFO closure after 30.2 years of follow-up.
Now, I was in my 40s when my PFO closure occurred, so I plan to live 30.2 years (and more, I hope!) afterward.


J.L. Murphey said...

Isn't there a less aggressive blood thinner you could take like plavix or aspirin? Warfin is a heavy duty blood thinner used in extreme cases.

Jeff Porter said...

I was on Plavix for a while, warfarin for a while, aspirin somewhere in there. Was on warfarin (which clearly didn't prevent everything!) when I had my TIA that led to my heart procedure in 2007. I take no blood-thinners now, which I'm grateful for.

J.L. Murphey said...

I agree with you. I was on Plavix before my heart attack. It was major. The verdict is still out on the Plavix this time around with strokes.