Antithrombotic therapy in patients with prosthetic heart valves

Ha Mohamed, Ha Mohamed

Abstract

Patients with mechanical valve prostheses require a lifelong anticoagulant treatment. The combined use of Warfarin and low-dose aspirin appears to reduce the risk of valve thrombosis and systemic embolism at a low risk of bleeding. The management of women with prosthetic heart valves during pregnancy poses a particular challenge, as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Oral anticoagulants, such as Warfarin, cause foetal embryopathy; unfractionated heparin and low-molecular-weight heparin have been reported to be ineffective in preventing thromboembolic complications. This article discusses the available data and the most recent guidelines in the antithrombotic management of patients with prosthetic valves, and antithrombotic therapy in various clinical situations such as pregnant women with prosthetic heart valves, and patients with prosthetic heart valves undergoing noncardiac surgery.

Keywords: Anticoagulation; Valve disease; Valve prosthesis.

References

    1. Grunkemeier GL, Starr A, Rahimtoola SH. Prosthetic heart valve performance: long-term follow-up. Curr Prob Cardiol. 1992;17:331–406.
    1. Butchart EG. Prosthetic Heart Valves. Cardiovascular Thrombosis. (Second edition) 1998:395–414.
    1. Kulik A, Rubens FD, Wells PS, Kearon C, Mesana TG, van Berkom J, Lam BK. Early postoperative anticoagulation after mechanical valve replacement: a systematic review. Ann Thorac Surg. 2006 Feb;81(2):770–81.
    1. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA. ACC/AHA guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol. 2008 Sep 23;52(13):e1–142.
    1. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152–8. tk;2.
    1. Turpie AG, Gent M, Laupacis A. A comparison of aspirin with placebo in patients treated with Warfarin after heart-valve replacement. N Engl J Med. 1993;329:524–9.
    1. Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25:1111–9.
    1. Peter M, Hoffmann A, Parker C, Luscher T, Burckhardt D. Progression of aortic stenosis: role of age and concomitant coronary artery disease. Chest. 1993;103:1715–9.
    1. Stein PD, Alpert JS, Copeland J, Dalen JE, Goldman S, Turpie AGG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest. 1995;108(suppl):s371–s379.
    1. Spyropoulos AC, Bauersachs RM, Omran H, Cohen M. Periprocedural bridging therapy in patients receiving chronic oral anticoagulation therapy. Curr Med Res Opin. 2006 Jun;22(6):1109–22.
    1. Khamooshi AJ, Kashfi F, Hoseini S, Tababaei MB, Javadpour H, Noohi F. Anticoagulation for prosthetic heart valves in pregnancy. Is there an answer? Asian Cardiovasc Thorac Ann. 2007 Dec;15(6):493–6.
    1. Sbarouni E, Oakley CM. Outcome of pregnancy in women with valve prostheses. Br Heart J. 1994;71:196–201.
    1. Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation. 2003;107:1240–6.
    1. Wong V, Cheng CH, Chan KC. Fetal and neonatal outcome of exposure to anticoagulants during pregnancy. Am J Med Genet. 1993;45:17–21.
    1. Ginsberg JS, Hirsh J. Use of antithrombotic agents during pregnancy. Chest. 1995;108:305S–11S.
    1. Elkayam UR. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol. 1996;27:1704–6.
    1. Descarries LM, Leduc L, Khairy P, Mercier LA. Low molecular weight heparin in pregnant women with prosthetic heart valves. J Heart Valve Dis. 2006 Sep;15(5):679–85.
    1. Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:627S–44S.

Source: PubMed

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