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Early antithrombotic management after valve replacement

M. Dahm*,1, G. Hafner2, H. Schinzel3, E. Mayer1, D. Prüfer1 and H. Oelert1

a Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
b Institute for Clinical Chemistry University Hospital Mainz, Mainz, Germany
c II. Medical Clinic, University Hospital Mainz, Mainz, Germany

* Correspondence: Prof. Dr. Manfred Dahm, Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.

Abstract

Because of the substantial risk of thromboembolism early after valve replacement, perioperative initiation of anticoagulation is necessary, despite the increased risk for bleeding. Anticoagulation should be initiated within 24 h after the procedure with unfractionated heparin or low-molecular-weight heparin (LMWH). Subcutaneous LMWH appears more beneficial than intravenous heparin therapy, but this approach requires further evaluation. Oral anticoagulants, preferably at low dosage, are added following the removal of chest tubes. Heparin anticoagulation is monitored by checking the activated partial thromboplastin time or anti-Xa activity, and the International Normalized Ratio (INR) is used to measure the effects of oral anticoagulants. Heparin treatment should be continued until the INR is stable in the therapeutic range in order to avoid hypercoagulable conditions caused by varying degrees of decay in coagulation factors.

Key Words: Early antithrombotic management • heart valve replacement • monitoring of oral anticoagulation


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