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[Anticoagulant management of patients with cardiac valve prostheses]
Insights
Anticoagulant management for China-made Björk-Shiley valves is effective, with low rates of thromboembolism (0.98/100 patient-years) and hemorrhage (1.86/100 patient-years). Surgical and pregnancy management strategies were successfully implemented.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Clinical Pharmacology
Context:
- Management of mechanical heart valves requires careful anticoagulation to prevent complications.
- China-made Björk-Shiley tilting disc cardiac valve prostheses present specific considerations for anticoagulation.
- Balancing anticoagulation efficacy with risks of thromboembolism and hemorrhage is crucial.
Purpose:
- To report methods and outcomes of anticoagulant management in patients with China-made Björk-Shiley valves.
- To evaluate the incidence of thromboembolic complications and anticoagulant-related hemorrhage.
- To describe strategies for managing anticoagulation during surgical procedures and in female patients.
Summary:
- This study analyzed 653 patients with China-made Björk-Shiley valves, reporting a thromboembolism incidence of 0.98 per 100 patient-years and hemorrhage incidence of 1.86 per 100 patient-years.
- Effective strategies were developed for maintaining or temporarily discontinuing anticoagulation during various surgical interventions.
- Favorable outcomes were achieved in managing anticoagulation for 303 female patients with considerations for menses, contraception, pregnancy, and delivery.
Impact:
- Demonstrates the feasibility and safety of established anticoagulation protocols for this specific mechanical heart valve prosthesis.
- Provides practical guidance for managing anticoagulation in patients undergoing surgery or facing pregnancy-related scenarios.
- Highlights the importance of individualized anticoagulation management for optimal patient outcomes.
Abstract:
This article reports the methods and results of anticoagulant management in 653 patients with China-made Björk-Shiley mode Tilting Disc Cardiac Valve Prostheses. The total incidence of thromboembolic complications and valve thrombosis is 0.98 per 100 patient-years during the anticoagulation. The incidence of anticoagulant-related hemorrhage is 1.86 per 100 patient-years. In the anticoagulant period, 61 surgical operations were performed on 58 patients. The results showed that anticoagulant can be maintained in minor, superficial operations where blood ooze can be arrested by compression, temporarily discontinued in elective operations, and reversed abruptly by injecting Vitamin K1 in urgent operations. In addition we handled the contradictions between anticoagulant therapy and menses, contraceptive, pregnancy or delivery (29 patients) for 303 female patients favorably. We conclude that our methods gave excellent results, and were reasonable and practicable.