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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

References

  1. Butchart EG, Lewis PA, Kulatilake EN, Breckenridge IM. Anticoagulation variability between centres: implications for comparative prosthetic valve assessment. Eur J Cardiothorac Surg. 1988;2:72–81[Abstract]
  2. Dahlke H, Dociu N, Thurau K. Thrombogenicity of different suture materials as revealed by scanning electron microscopy. J Biomed Mater Res. 1980;14:251–268[CrossRef][Web of Science][Medline]
  3. Badimon L, Badimon JJ, Turitto VT, Fuster V. Thrombosis: studies under flow conditions. Ann NY Acad Sci. 1987;516:527–540[Medline]
  4. Dewanjee MK, Trastek VF, Tago M, Torianni M, Kaye MP. Noninvasive radio-isotopic technique for detection of platelet deposition on bovine pericardial mural valve prostheses and in vitro quantification of visceral embolism in dogs. Trans Am Soc Artif Intern Organs. 1983;14:251–268
  5. Fuster V, Israel DH. Platelet inhibitor drugs after prosthetic heart valve replacement. Butchart EG, Bodnar E. Thrombosis, Embolism and Bleeding. London: ICR Publishers; 1992. p. 247–262
  6. Videm V, Mollnes TE, Fosse E, et al. Heparin-coated cardiopulmonary bypass equipment. Biocompatibility markers and development of complications in a high-risk population. J Thorac Cardiovasc Surg. 1999;117:794–802[Abstract/Free Full Text]
  7. British Society for Haematology. British Committee for Standards in Haematology. Haemostasis and Thrombosis Task Force: guidelines on oral anticoagulation: second edition. J Clin Pathol. 1990;43:177–183[Free Full Text]
  8. British Society for Haematology. British Committee for Standards in Haematology. Haemostasis and Thrombosis Task Force: guidelines on oral anticoagulation: third edition. Br J Haematol. 1998;101:374–387[CrossRef][Medline]
  9. Study Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Guidelines for prevention of thromboembolic events in valvular heart disease. Eur Heart J. 1995;16:1320–1330[Free Full Text]
  10. Stein PD, Alpert JS, Copeland J, Dalen JE, Goldman S, Turpie AGG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest. 1995;108:S371–S379 (suppl)
  11. Bonow RO, Carabello B, de Leon AC Jr, et al. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation. 1998;98:1949–1984[Free Full Text]
  12. Pepi M, Muratori M, Barbier P, et al. Pericardial effusion after cardiac surgery: incidence, site, size, and hemodynamic consequences. Br Heart J. 1994;72:327–331[Abstract/Free Full Text]
  13. Wilhelm M, Carrel T, Jenni R, Turina M. Incidence, clinical aspects and therapy of late pericardial tamponade following heart surgery. Swiss Surg. 1996;:92–96
  14. Hirsh J, Fuster V. Guide to anticoagulant therapy. Part 1: heparin. American Heart Association. Circulation. 1994;89:1449–1468[Free Full Text]
  15. Hirsh J, Fuster V. Guide to anticoagulant therapy. Part 2: oral anticoagulants. American Heart Association. Circulation. 1994;89:1469–1480[Free Full Text]
  16. Bruhn HD, Zurborn KH. The use of prothrombin fragment F1+2 to monitor the effect of oral anticoagulation. J Heart Valve Dis. 1995;4:138–140[Medline]
  17. Ageno W, Turpie AG. Exaggerated initial response to warfarin following heart valve replacement. Am J Cardiol. 1999;84:905–908[CrossRef][Web of Science][Medline]
  18. Kalter RD, Saul CM, Wetstein L, Soriano C, Reiss RE. Cardiopulmonary bypass associated hemostatic abnormalities. J Thorac Cardiovasc Surg. 1979;77:427–435[Web of Science][Medline]
  19. Weiss P, Soff GA, Halkin H, Seligsohn U. Decline of proteins C and S and factors II, VII, IX and X during the initiation of warfarm therapy. Thromb Res. 1987;45:783–790[CrossRef][Web of Science][Medline]
  20. Fennerty A, Dolben J, Thomas P, et al. Flexible induction dose regimen for warfarin and prediction of maintenance dose. BMJ. 1984;288:1268–1270
  21. Turpie AG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993;329:524–529[Abstract/Free Full Text]
  22. Weitz JI. Low molecular weight heparins. N Engl J Med. 1997;337:688–698[Free Full Text]
  23. Harenberg J, Huhle G, Piazolo L, Giese C, Heene DL. Long-term anticoagulation of outpatients with adverse events to oral anticoagulants using low molecular weight heparin. Semin Thromb Hemost. 1997;23:167–172[Medline]
  24. Lee LH, Liauw PCY, Ng ASH. Low molecular weight heparin for thromboprophylaxis during pregnancy in 2 patients with mural valve replacement. Thromb Haemost. 1996;76:628–630[Web of Science][Medline]
  25. Lev-Ran O, Kramer A, Gurevitch J, Shapira I, Mohr R. Low molecular weight heparin for prosthetic heart valves: treatment failure. Ann Thorac Surg. 2000;69:264–266[Abstract/Free Full Text]
  26. Montalescot G, Polle V, Collet JP, et al. Low-molecular-weight heparin after mechanical heart valve replacement. Circulation. 2000;101:1083–1086[Abstract/Free Full Text]
  27. Aguilar OM, Kleiman NS. Low molecular weight heparins. Exp Opin Pharmacother. 2000;1:1091–1103[CrossRef][Medline]
  28. Ginsberg J. Drug therapy: management of venous thromboembolism. N Engl J Med. 1996;335:1816–1828[Free Full Text]
  29. Laposata M, Green D, Van Cott EM, Barrowcliffe TW, Goodnight SH, Sosolik RC. College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: the clinical use and laboratory monitoring of low-molecular-weight heparin, danaparoid, hirudin and related compounds, and argatroban. Arch Pathol Lab Med. 1998;122:799–807[Web of Science][Medline]

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