Management of Life-Threatening Bleeding in Patients With Mechanical Heart Valves

Huda, Syed; Kahlown, Sara; Jilani, Mohammad Hashim; Chaudhuri, Debanik

doi:10.7759/cureus.15619

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…In addition, due to the light construction of the lea ets, they violently decelerate at the valve closure, which causes haemolysis by squeezing the blood cells. Studies on mechanical heart valves, including aortic valves, aim to decrease the risk of thrombosis, which requires anticoagulation treatment with various medicaments [30]. Such research is commonly conducted by means of in silico modelling.…”

Section: Discussionmentioning

confidence: 99%

Comparative analyses of blood flow through mechanical trileaflet and bileaflet aortic valves

Pawlikowski¹,

Nieroda²

2022

Acta Bioeng Biomech

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Purpose: The primary aim of the present study was to compare the bileaflet and trileaflet aortic valves’ performance during uniform blood flow model and boundary conditions. The secondary aim of the study was to determine the effect of Newtonian/non-Newtonian fluid flow assumption on blood flow directly behind the trileaflet valve. Methods: The geometrical model of the whole system consist of the left ventricle, fragment of the aorta and mechanical valves. A representation of pulsatile flow was obtained by measuring blood flow velocity (Doppler ultrasound examination). We have assumed turbulent blood flow. We considered two blood models, Newtonian and non-Newtonian (Carreau model). The valves’ performance was assessed using the reduced stress in the valves, the shear stress in the aortic wall, flow velocity field and the effective orifice area. Results: The maximum von Mises stress for the bileaflet valve leaflets was 0.3 MPa and for the trileaflet valve – 0.06 MPa. The maximum flow velocity for the bileaflet valve was 4.52 m/s for 40° and for the trileaflet valve – 5.74 m/s. Higher shear stress was present in the bileaflet (151.5 Pa) than for the trileaflet valve (49.64 Pa). Conclusions: The results indicate that central blood jet for the trileaflet valve contributes to more physiological blood flow and decreases the risk of haemolysis. The central flow minimises the risk of leaflet dislocation. In addition, lower stresses extend the durability of the valve. However, the trileaflet valve geometry has also disadvantages, for instance, small peripheral streams or relatively low effective orifice area.

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Section: Discussionmentioning

confidence: 99%

Comparative analyses of blood flow through mechanical trileaflet and bileaflet aortic valves

Pawlikowski¹,

Nieroda²

2022

Acta Bioeng Biomech

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“…However, patients with CF‐LVAD have higher bleeding rates than do patients exposed to these agents in other settings (e.g. mechanical valves) 24 . Moreover, many CF‐LVAD patients with GIB present with subtherapeutic or normal international normalized ratio (INR) at the time of bleeding.…”

Section: Pathophysiologymentioning

confidence: 99%

Gastrointestinal bleeding on continuous‐flow left ventricular assist device therapy

2023

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While technological advances in the field of continuous-flow left ventricular assist device (CF-LVAD) are constantly being made, CF-LVAD recipients are still subjected to a relatively high rate of LVAD-related adverse events, with post-LVAD gastrointestinal bleeding (GIB) being the most common one. GIB is associated with a significant impairment in quality of life, multiple hospital admissions, blood transfusion requirements and possibly death. Furthermore, of those patients who bled once, many will experience recurrent GIB events, which further aggravates their discomfort. While some medical and endoscopic treatment options are available, evidence regarding their benefit remains largely equivocal, with all related studies based on data from registries rather than clinical trials. Although having a major impact on LVAD recipients, an effective and validated pre-implant screening options to predict GIB events post-implant are scarce. This review focuses on the aetiology, incidence, risk factors, treatment options and the effect of new generation devices on post-LVAD GIB.

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“…Recognition of the severity of the bleeding and its origin is therefore essential. In a patient with a mechanical heart valve and a major haemorrhage, neutralisation of the anticoagulant should also be carried out while assessing the thrombotic risk associated with the delay before reintroduction of the anticoagulant [8]. Although activated charcoal is effective in reducing plasma concentrations of anticoagulants, its administration is not recommended in international guidelines in cases of major bleeding.…”

Section: Fatal Haemorrhagementioning

confidence: 99%

“…With treatment with acenocoumarol (Sintrom®, Merus Labs International, plasma elimination half-life 8-11 hours), warfarin (Coumandine®, Bristol-Myers Squibb, plasma elimination half-life 35-45 hours) or phenprocoumone (Marcoumar®, Meda, plasma elimination halflife 160 hours), the degree of anticoagulation is quantitatively reflected by prolongation of the PT (in seconds), most often reported as the prothrombin rate expressed as a percentage (PT%), or the INR, which increases when the PT% is lowered [8] . Many protocols rely on INR results to guide anticoagulation neutralisation.…”

Section: Vitamin K Antagonistsmentioning

confidence: 99%

Bleeding on oral anticoagulants: overview of reversal strategies

et al. 2023

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Oral anticoagulants (antivitamin K, direct oral anticoagulants) are routinely prescribed for the prevention or treatment of thromboembolic events, and many patients are now on long-term anticoagulant therapy. However, this complicates the management of urgent surgical conditions or major bleeding. Various strategies have been developed to reverse the anticoagulant effect and this narrative review provides an overview of the wide range of therapies currently available.

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Management of Life-Threatening Bleeding in Patients With Mechanical Heart Valves

Abstract: Huda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 4 publications

References 31 publications

Comparative analyses of blood flow through mechanical trileaflet and bileaflet aortic valves

Comparative analyses of blood flow through mechanical trileaflet and bileaflet aortic valves

Gastrointestinal bleeding on continuous‐flow left ventricular assist device therapy

Bleeding on oral anticoagulants: overview of reversal strategies

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