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Anticoagulation Management in Patients with Valve Replacement

Devendra Saksena1, S Muralidharan2, Yugal K Mishra3

  • 1Professor and Head, Dept. of Cardiac Surgery, Bombay Hospital, Mumbai, Maharashtra.

The Journal of the Association of Physicians of India
|October 21, 2018
PubMed

Insights

Postoperative anticoagulation with Vitamin K antagonists (VKAs) is recommended after prosthetic valve replacement to prevent thrombotic events. The efficacy of novel oral anticoagulants for these patients requires further investigation.

Area of Science:

  • Cardiology
  • Cardiothoracic Surgery
  • Pharmacology

Background:

  • Prosthetic valve implantation necessitates postoperative anticoagulation to prevent thrombotic events.
  • Thromboembolic events pose a significant risk within the first three months post-surgery for both mechanical and bioprosthetic valves.

Purpose of the Study:

  • To review and assess the role of anticoagulation therapy in managing patients with prosthetic heart valves.
  • To provide key practice points for cardiothoracic surgeons regarding anticoagulation post-valve replacement.

Main Methods:

  • Comprehensive literature search across PubMed, Embase, Medline, and Google Scholar.
  • Keywords included "valvular heart disease", "anticoagulant", "mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K antagonist (VKA)", and "acenocoumarol".
  • A committee of Indian cardiothoracic surgeons reviewed the literature and formulated practice recommendations.

Main Results:

  • Vitamin K antagonist (VKA) therapy with individualized target International Normalized Ratio (INR) is the recommended anticoagulation for patients post-prosthetic valve replacement.
  • Management strategies for prosthetic valve complications should be tailored to the specific complication type.
  • Particular attention and care are required for high-risk individuals and those with comorbidities.

Conclusions:

  • Anticoagulant therapy using VKAs appears effective for patients with prosthetic valve replacement.
  • The role of non-VKA oral anticoagulants in this patient population is not yet established.
  • The safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valves remain undetermined.
Abstract

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