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Thrombo-embolic and bleeding complications in patients with mechanical valve replacements--a prospective

E Schapkaitz1, B F Jacobson, P Becker

  • 1Department of Haematology and Molecular Medicine, National Health Laboratory Service and University of the Witwatersrand, Johannesburg.

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|October 5, 2006
PubMed

Insights

Lifelong oral anticoagulation therapy is safe and effective for mechanical heart valve recipients. However, double valve replacement patients face increased bleeding and thrombo-embolic risks, requiring further study.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Pharmacology

Background:

  • Mechanical heart valve replacement necessitates long-term anticoagulation to prevent thrombo-embolic events.
  • Dedicated anticoagulation clinics are crucial for managing indigent patients post-mechanical heart valve replacement surgery.

Purpose of the Study:

  • To assess the safety and efficacy of lifelong oral anticoagulation therapy in patients receiving mechanical heart valve replacements.
  • To document the incidence of bleeding and thrombo-embolic complications in patients with aortic valve replacements (AVRs), mitral valve replacements (MVRs), and double valve replacements (DVRs).

Main Methods:

  • A prospective observational study analyzed data from 306 patients at Johannesburg General Hospital's anticoagulation clinic (2000-2005).
  • Included 205 mechanical valve replacement patients (AVRs, MVRs, DVRs) and 101 non-mechanical valve controls.
  • International Normalized Ratio (INR) levels and complication occurrences were documented at each visit.

Main Results:

  • A total of 51 bleeding and thrombo-embolic complications were recorded.
  • Double valve replacement (DVR) patients exhibited a higher complication rate (30.61%) compared to single valve replacements and controls.
  • High-quality anticoagulant control (82% within therapeutic INR range) was achieved and did not contribute to complications.

Conclusions:

  • Low complication rates support the continued use of mechanical valves and oral anticoagulation (INR 2.5-3.5).
  • The elevated risk of complications in DVR patients warrants further investigation and clinical concern.
Abstract

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