Document Detail


Anticoagulation in valvular heart disease preoperatively and postoperatively.
MedLine Citation:
PMID:  6722854     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We have reviewed the risks and benefits of anticoagulation for cardiac valve disease before and after valve surgery. Though the absence of standardized reporting of complications and the paucity of well-designed comparative studies mandate careful consideration of the variables of individual cases, we have made the following general recommendations: Unoperated patients with rheumatic mitral valvular disease and atrial fibrillation should be chronically treated with warfarin, regardless of the hemodynamic severity of their valvular lesion. The presence of right- or left-sided heart failure is an indication for warfarin treatment, in the absence of significant contraindications. There is emerging evidence that platelet-suppressant therapy may be of benefit in diminishing the thromboembolic risk of at least a subset of patients with rheumatic valvular disease and decreased platelet survival. Until platelet-survival studies are more readily available and larger-scale studies can be performed, however, we do not recommend routine treatment with platelet-active agents. We recommend chronic warfarin anticoagulation in all patients with mechanical prostheses in either the aortic or mitral position, regardless of cardiac rhythm or prosthesis model. We do not routinely add platelet-active agents except in the case of embolism despite adequate anticoagulation with warfarin. Patients with aortic bioprostheses generally do not require warfarin treatment for more than 3 months following valve replacement. The presence of atrial fibrillation and marked depression of postoperative ventricular function are indications for chronic anticoagulation. In the case of mitral bioprostheses, we recommend indefinite warfarin treatment for patients with atrial fibrillation, depressed ventricular function, or low cardiac output. We consider a preoperative history of embolism or an operative finding of left atrial thrombus to be an additional indication for anticoagulation, in the absence of significant contraindications. Patients on anticoagulant therapy should be followed closely--when possible in specialized anticoagulation clinics--to minimize the risks of treatment. Specific recommendations are made for management of anticoagulation during infective endocarditis, pregnancy, and noncardiac surgery.
Authors:
A G Bodnar; A M Hutter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular clinics     Volume:  14     ISSN:  0069-0384     ISO Abbreviation:  Cardiovasc Clin     Publication Date:  1984  
Date Detail:
Created Date:  1984-07-20     Completed Date:  1984-07-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0213744     Medline TA:  Cardiovasc Clin     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  247-64     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / adverse effects,  therapeutic use*
Aortic Valve / surgery
Bioprosthesis
Embolism / prevention & control*
Female
Heart Valve Diseases / surgery*
Heart Valve Prosthesis
Humans
Mitral Valve / surgery
Postoperative Care
Pregnancy
Pregnancy Complications, Cardiovascular / surgery
Preoperative Care
Prognosis
Risk
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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