Mechanical heart valve prostheses and persistent lupus anticoagulant: is the thrombotic risk increased?

Abstract

The risk of thrombosis in patients with mechanical heart valve prostheses in spite of life-long adequate anticoagulation is 1-2% per year. Current recommendations for anticoagulation take into account the prosthesis itself and the co-morbid conditions that enhance the thrombotic risk. Lupus anticoagulant is diagnosed in many thrombotic recurrences. We designed an ambispective case-control study to evaluate thrombotic events in patients with mechanical heart valve prostheses and persistent lupus anticoagulant. Our objectives were to determine whether persistent lupus anticoagulant increased the risk of embolism in that population and thus, if a more intense anticoagulation would be recommended, even at the risk of increasing bleeding episodes. We included 16 patients and 16 controls with more than 80 patient-years of follow-up and with other risk factors for embolism. We observed no increased rate of thromboembolic events in patients than in controls, even during high-risk situations (i.e. bacterial endocarditis). Our population spent most of the time within the intended anticoagulation range. We conclude that adequate anticoagulation is the most important issue to prevent events, protecting against thrombosis without increasing the bleeding risk.

Influence of Systemic Lupus Erythematosus on Procedure Selection and Outcomes of Patients Undergoing Isolated Mitral Valve Surgery

“…On the one hand, bioprostheses are prone to developing Libman‐Sacks endocarditis on the new valve, while on the other, mechanical prostheses can be problematic in these already hypercoaguable patients 17,18 . The young age of lupus patients at presentation is consistent with recommendations for mechanical prostheses as long as the patients stay within the intended anticoagulation range 17,19 . The presence or absence of secondary APS is another factor to be given consideration.…”

“…17,18 The young age of lupus patients at presentation is consistent with recommendations for mechanical prostheses as long as the patients stay within the intended anticoagulation range. 17,19 The presence or absence of secondary APS is another factor to be given consideration. In addition, a mechanical valve is recommended for patients with atrial fibrillation since anticoagulant therapy is already indicated.…”