Abstract
Nearly four decades have passed since the first mechanical prosthetic aortic valve was placed. Since then several design changes and modifications have been made to improve longevity and hemodynamics and reduce thrombogenicity. Despite these advances thromboembolism remains the major problem for mechanical prosthetic valves. The type and the position of the prosthetic valve and several clinical characteristics such as age greater than 70, atrial fibrillation, depressed left ventricular systolic function, left atrial enlargement, left atrial thrombus and a prior history of systemic embolization influence the risk of thromboembolism and the level of anticoagulation needed to prevent this complication. Through clinical experience guidelines have been developed by the American College of Chest Physicians to determine the optimal level of anticoagulation needed to lower the thromboembolic rate with an acceptable hemorrhagic event rate.
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Vongpatanasin W, Hillis D, Lange RA. Prosthetic heart valves. New Engl J Med 335;6:407-416.
Nitter-Hauge S. Mechanical heart valves. Conclusions from long-term follow up. Eur Heart J 1997;18:907-910.
Cannegieter SC, Rosendaal FR, Briet E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 1994;2:635-641.
Tiede DJ, Nishmura RA, Gastineau DA, Mullany CJ, Orszulak TA, Schaff HV. Modern management of prosthetic valve anticoagulation. Mayo Clin Proc 1998;73:665-680.
Stein PD, Grandison D, Hua TA, et al. Therapeutic level of oral anticoagulation with warfarin in patients with mechanical prosthetic heart valves: Review of literature and recommendations based on international normalized ratio. Postgrad Med J 1994;70(suppl 1):S72-S83.
Cannegieter SC, Rosendaal ER, Wintzen AR, Van der Meer FJM, Vandenbroucke JP, Briet E. Optimal oral anticoagulant therapy in patients with mechanical heart valves. New Engl J Med 1995;333;1:11-17.
Turpie AG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated warfarin after heart-valve replacement. New Engl J Med 1993;329;8:524-529.
Meschengieser SS, Fondevila CG, Frontroth J, Santarelli MT, Lazzari MA. Low intensity oral anticoagulation plus low dose aspirin versus high intensity oral anticoagulation alone: A randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg 1997;113:910-916.
Altman R, Rouvier J, Gurfinkel E, D'Ortencio O, Manzanel R, de la Fuente L. Comparison of two levels of anticoagulant therapy in patients with substitute heart valves. J Thorac Cardiovasc Surg 1991;101:427-431.
Saour JN, Sieck JO, Mamo LAR, Gallus AS. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. New Engl J Med 1990;322:428-432.
Butchart EG, Lewis PA, Bethel JA, Breckenridge IM. Adjusting anticoagulation to prosthesis thrombogenicity and patient risk factors: Recommendations for the Medtronic Hall Valve. Circulation 1991;84(suppl 3):III61-III69.
Horskotte D, Schulte H, Bircks W, Strauer B. Unexpected findings concerning thromboembolic complications and anticoagulation after complete 10 y follow up of patients with St. Jude Medical prostheses. J Heart Valve Dis 1993;2:291-301.
Acar J. Low-dose versus standard-dose anticoagulation for prosthetic heart valves. Circulation 1995;92:2360.
Barwolf CG, Krozingen B, Acar J, et al. Guidelines for prevention of thromboembolic events in valvular heart disease. Eur Heart J 1995;16:1320-1330.
Heras M, Chesebro JH, Fuster V. High risk of early thromboemboli after bioprosthetic cardiac valve replacement. J Thorac Cardiovasc Surg 1985;89:499-507.
Louagie YA, Jamart J, Eucher P. Mitral valve Carpentier-Edwards bioprosthetic replacement, thromboembolism, and anticoagulants. Ann Thorac Surg 1993;56:931-937.
Stein PD, Collins JJ Jr, Kantrowitz A. Antithrombotic therapy in mechanical and biological prosthetic heart valves and saphenous vein bypass grafts. Chest 1986;89(suppl 2):46S-53S.
Stein PD, Alpert JS, Copeland J, Dalen JE, Goldman S, Turpie AG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 1992;102(suppl 4):445S-455S.
Stein PD, Alpert JS, Copeland J, Dalen JE, Goldman S, Turpie AG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 1995;108(suppl 4):371S-379S.
Fifth ACCP Consensus Conference on Antithrombotic Therapy. Chest 1998;114:439S-769S.
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Mercadante, N. Management of Patients with Prosthetic Heart Valves: Potential Impact of Valve Site, Clinical Characteristics, and Comorbidity. J Thromb Thrombolysis 10, 29–34 (2000). https://doi.org/10.1023/A:1018742620401
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DOI: https://doi.org/10.1023/A:1018742620401