Posted by steve giddings on January 10, 2002 at 10:58:50:
In Reply to: again the coumadin posted by hans koster on January 10, 2002 at 05:33:57:
Hans, I would never want to second guess a physician, but most who care for post op maze patients who have been in persistent NSR seem to be willing to let their patients go without anticaogulation at some point after surgery. The issue of atrial transport (particularly left atrial transport) in maze patients is a bit contentious. Several studies say that it doesn't return in a relatively large minority of patients. Those who say it does say that the studies that indicate it doesn't were (a) done too soon post op and (b) used the wrong measurement tool, standard transthoracic echo vs transesohpageal echo, which gives a better view of the left atrium. The studies which do the latter indicate that virtually everyone gets return of left atrial transport, but that it remains reduced. It has to be decreased because the maze line that is placed around the base of the pulmonary veins isolates about 25% of the LA from any electrical signal, and so that portion never contributes to atrial contraction post op.
Probably the best way to look at the coumadin issue is to measure the incidence of stroke in MAZE patients post op. This is astoundingly low. Most maze patients are relatively younger and healthier than the average patient with Atrial fibrillation, They have also had their left atrial appendage removed as part of the procedure, and this is the site for formation of most left atrial clots. All these factors likely make stroke risk intrinsically lower than the average patient with AF.
I'm pretty conservative. I don't take coumadin. I do take an aspirin (full size) each day, Even though I have had an episode of atrial flutter post op. My reasoning is my stroke risk is low based on all the above. If I go into flutter, I know it, and I can get on injectable anticoagulant (lovenox) immediately and start coumadin if I have to.
That's all I know