Author + information
- Pratik Kanabur,
- Onyedika Ilonze and
- Timothy Ball
Background: After valve repair with a mechanical valve, patients are placed on indefinite anticoagulation with a Vitamin K antagonist due to statistically significant reductions in the rate of systemic embolization. However, the risk of bleeding is also substantial, and when these patients present with anticoagulant related hemorrhagic complications, physicians are often reluctant to reverse anticoagulation or withhold warfarin treatments due to the risk on an adverse thromboembolic event.
Methods: A retrospective chart review was done on patients at Carilion Roanoke Memorial Hospital with mechanical heart valves who presented with bleeding and had an interruption and reversal of anticoagulation. The primary outcome measured was the incidence of thromboembolic events during the period the anticoagulation was stopped as well as within 30 days of follow-up after anticoagulation was resumed.
Results: 46 patients met the inclusion criteria. The results are summarized in the table below. Only one patient had an adverse thromboembolic event, which was a CVA 60 days after warfarin was stopped.
Conclusions: For patients with mechanical valves on lifelong anticoagulation that present with major bleeding, treatment should consist of reversing the anticoagulation and withholding the anticoagulation. Anticoagulants can be held with adequate patient monitoring and resumed when felt to be safe without overtly worrying about risk of adverse thromboembolic phenomenon.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Changing the Natural History of Valve Disease With Medical Therapy
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1185-032
- 2017 American College of Cardiology Foundation