title: Anticoagulation dilemma in a high-risk patient with On-X valves.
abstract: Thromboembolism continues to be a major concern in patients with mechanical heart valves, especially in those with unsatisfactory anticoagulation levels. The new On-X valve (On-X Life Technologies, Austin, TX, USA) has been reported as having unique structural characteristics that offer lower thrombogenicity to the valve. We report a case where the patient received no or minimal systemic anticoagulation after placement of On-X mitral and aortic valves due to development of severe mucosal arterio-venous malformations yet did not show any evidence of thromboembolism. This case report reinforces the findings of recent studies that lower anticoagulation levels may be acceptable in patients with On-X valves and suggests this valve may be particularly useful in those in whom therapeutic levels of anticoagulation cannot be achieved due to increased risk of bleeding.
authors: Ami M
authors: AM
authors: Karkar
authors: Manuel R
authors: MR
authors: Castresana
authors: Nadine
authors: N
authors: Odo
authors: Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.
authors: Shvetank
authors: S
authors: Agarwal
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation; D004867:Equipment Design; D017809:Fatal Outcome; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin