Delayed Presentation of Low Molecular Weight Heparin Treatment Failure in a Patient With Mitral Valve Prosthesis

Abstract

We describe a patient who developed right basal ganglion stroke and partial obstruction of St. Jude mitral valve prosthesis as a result of treatment failure with enoxaparin. The patient did not develop the embolic complication from the thrombosis until almost 4 months after the bridging sequence with low molecular weight heparin. The patient underwent thrombectomy of the mitral valve. At least 16 similar cases with mechanical valve prostheses and treatment failure of low molecular weight heparin have been reported.

Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis

“…Bridging therapy with a standardized low molecular weight heparin-based regimen has been reported effective and relatively safe in a large cohort of patients with mechanical heart valves [3]. Many cases with mitral mechanical valve prostheses and treatment failure of low molecular weight heparin have also been reported [4] as well as prosthetic valve thrombosis has been reported with adequate anticoagulation [5]. A case has also been reported of well functioning Starr-Edwards aortic prosthesis without anticoagulation [6,7].…”

Acenocoumarol and Pregnancy Outcome in a Patient with Mitral Valve Prosthesis: A Case Report

“…However, several cases of mechanical valve thrombosis during LMWH treatment have been reported, most of them in pregnant patients [24][25][26] . The FDA has issued additions to the warnings and precaution sections of the Lovenox (enoxaparin sodium) product labeling [27,28] . These warnings point out that enoxaparin is not recommended for thrombotic prophylaxis in patients with prosthetic heart valves and that cases of valve thrombosis and of maternal deaths have been reported with use of this drug (http://www.fda.gov/medwatch).…”

Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation

“…Bridging therapy with a standardized low molecular weight heparin-based regimen has been reported effective and relatively safe in a large cohort of patients with mechanical heart valves [6]. Many cases with mitral mechanical valve prostheses and treatment failure of low molecular weight heparin have also been reported [7] as well as prosthetic valve thrombosis has been reported with adequate anticoagulation [8]. A case has also been reported of well functioning Starr-Edwards aortic prosthesis without anticoagulation [9,10] and a case of cardioembolic stroke in a patient with an aortic mechanical prosthesis in bridging therapy with LMWH has been also reported [3].…”