Rivaroxaban and dabigatran for suppression of mechanical heart valve-induced thrombin generation
ConclusionsWhereas warfarin suppresses MHV-induced thrombin generation, MHVs induce the generation of factor Xa in concentrations that overwhelm clinically relevant concentrations of rivaroxaban or apixaban. When used in combination, rivaroxaban and dabigatran are more effective than either agent alone suggesting that concomitant inhibition of factor Xa and thrombin is better than inhibition of either clotting enzyme alone.
Diagnosis, treatment &management of prosthetic valve thrombosis: the key considerations. Expert Rev Med Devices. 2020 Feb 21;: Authors: Gündüz S, Kalçık M, Gürsoy MO, Güner A, Özkan M Abstract Introduction: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.Areas covered: The etiopathogenesis, diagnosis and management of prosthetic heart valve thrombosis with particular focus on conventional...
ConclusionsThis is the largest series to date reporting>30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.
ConclusionsIn this study, the complex flow field characteristics in the new generation of BMHVs considering aorta flexibility with healthy and calcified annulus were investigated. It was found that the blood flow around the hinges region is in the danger of hemolysis and platelet activation and subsequently thromboembolism. Furthermore, the results show that similar to vessel wall deformation, considering the probable annulus calcification after valve replacement is also essential.
Rationale: Heart-valve replacement is one of the main surgical methods for various heart-valve diseases. Warfarin is the only oral anticoagulant used for thrombosis prevention after heart-valve replacement. However, warfarin has a narrow therapeutic window, large differences in efficacy between individuals, and can be affected by drugs, food and disease status. Patient concerns: We used the Hamberg model to develop an anticoagulation regimen for a 10-month-old Chinese male after mitral-valve replacement. Diagnoses: Echocardiography revealed mitral malformation with severe regurgitation, patent foramen ovale, thicke...
Conclusion: Our meta-analysis suggests that LMWH not only reduces the risk of thromboembolism in patients with MHV but also does not increase the risk of major bleeding. LMWH may provide safer and more effective bridging anticoagulation than UFH in patients with MHV. It is still necessary to conduct future randomized studies to verify this conclusion.
We report a case of successful long‐term anticoagulation with enoxaparin in a patient with a mechanical aortic valve who had a contraindication to warfarin. The patient developed a left thigh hematoma requiring surgical evacuation one month after initiation of weight‐based dosing of e noxaparin. His dose was then titrated based on peak anti–Xa levels (goal 0.6–1.0 IU/mL). He remained free of signs and symptoms of thromboembolic events, valve dysfunction, bleeding complications, or major adverse effects from long‐term enoxaparin use for the next 13 years. Our case provides p romising evidence of the potent...
CONCLUSIONS: Whereas warfarin suppresses MHV-induced thrombin generation, MHVs induce the generation of factor Xa in concentrations that overwhelm clinically relevant concentrations of rivaroxaban or apixaban. When used in combination, rivaroxaban and dabigatran are more effective than either agent alone suggesting that concomitant inhibition of factor Xa and thrombin is better than inhibition of either clotting enzyme alone. PMID: 31877292 [PubMed - as supplied by publisher]
CONCLUSIONS: In order to achieve optimal outcomes by maintaining effective anticoagulant dosing while entailing minimal risk in Chinese patients that have undergone a bileaflet mechanical valve replacement, the target INR range should be between 1.5 and 2.5, with the final intensity of this anticoagulant regimen being determined based on a given patient's risk of thromboembolism. PMID: 31866562 [PubMed - as supplied by publisher]
Patients with mechanical heart valves are still not eligible for treatment with direct oral anticoagulants (DOAC). We aimed to conduct a proof-of-principle study investigating the anti-Xa inhibitor rivaroxaban as antithrombotic treatment in patients with recent mechanical aortic valve replacement.
ConclusionPatient carried a mutant of RYR1 gene could possibly lead to MH development post anaesthesia of cardiac surgery.