Document Detail


Early postoperative anticoagulation after mechanical valve replacement: a systematic review.
MedLine Citation:
PMID:  16427905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal approach to early postoperative anticoagulation after mechanical valve implantation remains controversial. This review article examines the pathogenesis of thrombus formation and the different strategies for early postoperative anticoagulation. The most commonly reported anticoagulation regimens had the after estimates of early postoperative thromboembolism and hemorrhage: oral anticoagulation alone (0.9%, 3.3%); oral anticoagulation with intravenous unfractionated heparin (1.1%, 7.2%); and oral anticoagulation with low molecular weight heparin (0.6%, 4.8%). Although intravenous heparin may be associated with a higher incidence of hemorrhage, a randomized trial is needed to provide the best evidence regarding early postoperative anticoagulation after mechanical valve implantation. Nearly four decades have passed since the first mechanical prosthetic valves were implanted. Frequent thromboembolic complications with the first mechanical valves led to recommendations of universal anticoagulation for these patients. Since then, several design changes and modifications have been made to improve the longevity, hemodynamics, and thrombogenicity of newer generation mechanical valves. With improved blood flow, less stasis, and less thrombogenic materials, lower rates of thromboembolism have been reported. Despite these advances however, thromboembolism and anticoagulant-related bleeding continue to account for 75% of all complications after mechanical valve replacement. Occurring most commonly within six months after implantation, these complications can adversely affect mortality and quality of life. Furthermore, the threat of their occurrence creates a psychological burden for each patient with a mechanical valve. The need for life-long anticoagulation in patients with mechanical valves is not in dispute, and the perioperative management of anticoagulation during non-cardiac surgery has been reviewed extensively. However, the approach to early postoperative anticoagulation after mechanical valve implantation is still a matter of debate. The optimal intensity and timing of anticoagulation to prevent early thromboembolism after valve replacement surgery without postoperative bleeding complications is unknown. Hence, many anticoagulation protocols have been proposed, but a lack of consensus remains. The objectives of this study were (1) to reexamine the pathogenesis of thrombus formation and the need for anticoagulation; (2) to critically review the literature on early postoperative anticoagulation strategies; and (3) provide an estimate of the incidence of bleeding and thromboembolism for each approach to early postoperative anticoagulation.
Authors:
Alexander Kulik; Fraser D Rubens; Philip S Wells; Clive Kearon; Thierry G Mesana; Judith van Berkom; B-Khanh Lam
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  81     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-08-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  770-81     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa Hospital, Ottawa, Canada.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Anticoagulants / administration & dosage,  therapeutic use*
Drug Therapy, Combination
Heart Valve Prosthesis Implantation*
Hemorrhage / chemically induced
Heparin / administration & dosage,  therapeutic use
Humans
Platelet Aggregation Inhibitors / therapeutic use
Postoperative Care
Postoperative Complications / prevention & control
Risk Factors
Thromboembolism / physiopathology,  prevention & control*
Warfarin / administration & dosage,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 81-81-2/Warfarin; 9005-49-6/Heparin

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


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