9/10/2023 0 Comments Inr normal range mechanical valveHowever, one-third of the patients had mitral ball-in-cage prostheses, which are associated with high rates of thromboembolism. In an earlier series of 112 patients who underwent mechanical mitral valve replacement between 19 and were anticoagulated with a VKA (with mean international normalized ratio of 3), the rate of thromboembolic events was 6 percent during the first 30 days.In a prospective series of 149 patients who underwent mitral (or mitral plus aortic) mechanical valve replacement between December 2005 and May 2007 and were anticoagulated with a vitamin K antagonist (VKA such as warfarin) with early bridging with intravenous (IV) unfractionated heparin (UFH), thromboembolic events during the first 30 days occurred in 22 patients (14.8 percent).Mitral valve – The risk of thromboembolism during the first 30 days after mechanical mitral valve implantation is high, even with therapeutic anticoagulation, as illustrated by the following studies:.In an observational study, risk factors for early thromboembolism included temporary cessation of anticoagulation for pacemaker implantation and diabetes mellitus. While the relative risk of thromboembolism is high during the first three to six months after valve replacement, the period of highest risk is relatively short, which limits the absolute risk of thromboembolism in the early postoperative period. Thromboembolic risk varies with time after mechanical valve implantation (highest early on), valve position (higher for mitral than aortic valves), and valve type (highest for older generation valves, particularly ball-in-cage).Įarly risk - Following mechanical valve replacement, the risk of thromboembolism is highest during the first three to six months (particularly the first 30 days), even with therapeutic-dose anticoagulation. Thromboembolism - The term thromboembolism generally refers to clinical embolic events ascribed to thrombus. Thromboembolic and anticoagulation-related problems are the most frequent complications of mechanical valves. Thrombotic risk is higher with mechanical valves than with bioprosthetic valves. RISK OF THROMBOTIC COMPLICATIONS - The two major thrombotic complications of prosthetic valves are thromboembolism and prosthetic valve thrombosis (PVT). (See "Diagnosis of mechanical prosthetic valve thrombosis or obstruction" and "Management of mechanical prosthetic valve thrombosis and obstruction".) (See "Anticoagulation for prosthetic heart valves: Management of bleeding and invasive procedures".).(See "Management of antithrombotic therapy for a prosthetic heart valve during pregnancy".).(See "Overview of the management of patients with prosthetic heart valves".).Related subjects are presented separately, including: Antithrombotic therapy refers to use of anticoagulants, antiplatelet agents, or both. This topic will review the approach to antithrombotic therapy for patients with mechanical heart valves. Complications include embolic events, valve obstruction (due to thrombosis or pannus), bleeding complications of antithrombotic therapy, infective endocarditis, paravalvular and transvalvular regurgitation, hemolytic anemia, and patient-prosthesis mismatch. The frequency of serious complications depends on the valve type, position, and other clinical risk factors. INTRODUCTION - Surgical replacement of a diseased heart valve with a prosthetic valve aims to improve symptoms and prolong life but also exposes the patient to potential prosthesis-related complications.
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