- Tiede DJ, Nishimura RA, Gastineau DA, et al (Mayo Clinic Rochester, Minn)
Modern Management of Prosthetic Valve Anticoagulation
Mayo Clin Proc 73: 665-680, 1998
Systemic anticoagulation reduces incidence of valve thrombosis and systemic embolism in patients with prosthetic heart valves. Optimum intensity of anticoagulation is not known. Mayo clinic recommended regimen for anticoagulation, its practical implications and suggestions for anticoagulation for such patients undergoing non-cardiac surgery are discussed.
Higher levels of anticoagulation reduce risk of thromboembolic events but increase risk of bleeding. It is suggested that anticoagulants may be discontinued for 3 to 5 days before surgery and resumed 3 to 5 days after surgery with decreased risk of intra-operative bleeding and no increase in the risk of thromboembolic events.
Pregnancy poses a bleeding risk for the mother as well as the foetus because some anticoagulants cross the placental barrier. Drugs and diet also influence the level of anticoagulation achieved.
Individual patients need individual adjustments to anticoagulation.
- Thourani VH, Weintraub WS, Craver JM, et al (Emury Univ, Atlanta, GA)
Ten-Year Trends in Heart Valve Replacement Operations
Ann Thorac Surg 70: 448-455, 2000
Improvements in medical and surgical care have allowed cardiovascular procedures to be offered to patients who were previously thought inoperable. Anxieties have been expressed about the cost of such procedures and outcomes in such patients.
Records of last 10 years were evaluated to determine the outcomes. Records of 2972 patients operated between 1988 to 1997 were reviewed. A total of 204 had combined aortic and mitral valve replacement (AVR + MVR). 966 had mitral valve replacement (MVR) and 1802 had aortic valve replacement (AVR).
Ten year studies have revealed that though sicker and older patients have been operated, the outcomes have improved and the hospital stay and costs have declined significantly.