Failure of guideline-based anticoagulation in a patient with mitral prosthetic valve and recurrent thromboembolism.
Prosthetic valve (PV)-related thromboembolism is a rare but serious complication of implanted mechanical valves. There is not a design that has yet achieved mechanical perfection; therefore, using these mechanical valves is not free of mortality and morbidity. Some of the complications of using such valves include PV thrombosis, systemic embolization, bleeding, endocarditis, perivalvular leak, and structural valve failure. These valves are thrombogenic, and their use requires anticoagulation postoperatively to prevent systemic embolization and PV thrombosis. This intervention also carries the risk of bleeding, which can be detrimental for a subset of patients, especially elderly, pregnant, and those with other systemic comorbidities. In this case we present a patient with recurrent thromboembolic events and a nonobstructing St. Jude mitral PV thrombosis despite vigorous anticoagulation with Coumadin (Bristol-Myers Squibb Co., Princeton, NJ) and aspirin.
Department of Medicine, Berkshire Medical Center, Pittsfield, Massachusetts 01201, USA. histanbul@yahoo.com
Halil
H
Mutlu
Mustafa E
ME
Yerlioglu
William K
WK
Levy
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery; D017410:Practice Guidelines as Topic; D011475:Prosthesis Failure; D055502:Secondary Prevention; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D017211:Treatment Failure
D000925:Anticoagulants