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[Thromboembolic and hemorrhagic complications in valve prosthesis patients]
Insights
Patients with artificial heart valves on anticoagulant therapy face high risks of thrombo-embolic events, especially with mitral valve replacements. Even regular treatment doesn't eliminate these risks or prevent serious bleeding complications.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Context:
- Anticoagulant therapy is crucial for patients with artificial heart valves to prevent thromboembolic complications.
- Valve replacement surgeries, particularly mitral and polyvalvular procedures, necessitate long-term management.
- Patient adherence and the effectiveness of anticoagulant regimens are critical factors in outcomes.
Purpose:
- To evaluate the incidence and characteristics of thromboembolic and hemorrhagic complications in patients with artificial heart valves undergoing anticoagulant therapy.
- To identify risk factors associated with these complications, including prosthesis type and treatment regularity.
- To assess the efficacy and safety profile of anticoagulant therapy in this patient population.
Summary:
- A study followed 567 patients with artificial heart valves on anticoagulant therapy for a mean of 53 months.
- Thromboembolic episodes occurred in 11.6% of patients (4.6 per 100 patient-years), with higher rates in mitral and polyvalvular replacements.
- Hemorrhagic complications affected 9.7% of patients, with both types of events occurring even with regular treatment.
Impact:
- Findings highlight a significant risk of thromboembolic events in specific patient groups, underscoring the need for tailored anticoagulant strategies.
- The study indicates that even well-managed anticoagulant therapy carries a substantial risk of hemorrhage, necessitating careful monitoring.
- Results emphasize the complexity of managing anticoagulation in artificial heart valve patients, balancing thrombotic and bleeding risks.
Abstract:
567 patients with valve prostheses who received anticoagulant therapy were followed up by Professor Ben-Ismail's department at the Ernest-Conseil Hospital, over a period of 2 to 160 months (mean: 53 months). 220 of them had a mitral prosthesis, 183 had an aortic prosthesis and 161 had a double (153) or triple (8) valvular replacement. 66 patients (11.6%) presented a total of 85 thrombo-embolic episodes, i.e. a global incidence of 4.6 emboli per 100 patient-years. Amongst the thrombo-embolic incidents, there were 26 cases of valvular thrombosis, 47 cases of cerebral vascular accident and 11 cases of peripheral vascular emboli. The course was fatal in 18 cases. These accidents mostly occurred in the cases with mitral or polyvalvular replacements. More than one half of these patients were pursuing a regular and effective treatment. 55 patients presented a total of 60 serious haemorrhagic accidents, of which 10 died. This study reveals that the incidence of thrombo-embolic accidents is much higher in patients with mitral or tricuspid valve replacements and when the anticoagulant treatment is irregular or capricious. However, an apparently well managed anticoagulant treatment does not prevent the development of thrombo-embolic accidents and carries a significant risk of haemorrhage.