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Mechanical heart valve prostheses and persistent lupus anticoagulant: is the thrombotic risk increased?

Patricia Casais1, Susana S Meschengieser, Laura C Gennari

  • 1Hemostasis and Thrombosis Department, Institute of Hematological Research, National Academy of Medicine, Buenos Aires, Argentina. casais@hematologia.anm.edu.ar

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|March 30, 2005
PubMed

Insights

Patients with mechanical heart valves and lupus anticoagulant do not face increased embolism risk with standard anticoagulation. Adequate anticoagulation effectively prevents thrombosis without raising bleeding concerns.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Mechanical heart valve prostheses carry a 1-2% annual risk of thrombosis despite anticoagulation.
  • Lupus anticoagulant is frequently observed in patients experiencing recurrent thrombotic events.
  • Current anticoagulation guidelines consider prosthesis type and patient comorbidities.

Purpose of the Study:

  • To evaluate thrombotic events in patients with mechanical heart valve prostheses and persistent lupus anticoagulant.
  • To determine if lupus anticoagulant increases embolism risk in this population.
  • To assess the need for intensified anticoagulation versus bleeding risk.

Main Methods:

  • Ambispective case-control study design.
  • Inclusion of 16 patients with mechanical heart valves and persistent lupus anticoagulant, and 16 matched controls.
  • Over 80 patient-years of follow-up, accounting for other embolism risk factors.

Main Results:

  • No significant difference in thromboembolic event rates between patients with lupus anticoagulant and controls.
  • Thromboembolic events were not elevated even during high-risk periods like bacterial endocarditis.
  • The study population maintained therapeutic anticoagulation levels for most of the follow-up duration.

Conclusions:

  • Adequate anticoagulation is paramount for preventing thromboembolic events in mechanical heart valve patients.
  • Persistent lupus anticoagulant does not appear to increase thrombotic risk when anticoagulation is maintained within the target range.
  • Intensified anticoagulation is not necessarily indicated solely due to the presence of lupus anticoagulant, preserving a balance against bleeding complications.

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