title: The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.
abstract: BACKGROUND
  It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement.
  
  
  METHODS
  We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
  
  
  RESULTS
  For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
  
  
  CONCLUSIONS
  The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
authors.affiliation: Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Aliasghar
authors.initials: A
authors.lastname: Moeinipour
authors.affiliation: Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Zarifian
authors.affiliation: Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Mohammad Sobhan
authors.initials: MS
authors.lastname: Sheikh Andalibi
authors.affiliation: Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Alireza Sepehri
authors.initials: AS
authors.lastname: Shamloo
authors.affiliation: Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmadabadi
authors.affiliation: Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Amouzeshi
authors.affiliation: Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hoseinikhah
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K