Thromboembolism, major bleeding and mortality in patients with mechanical heart valves- a population-based cohort study

Labaf, Ashkan; Grzymala-Lubanski, Bartosz; Stagmo, Martin; Lövdahl, Susanna; Wieloch, Mattias; Själander, Anders; Svensson, Peter

doi:10.1016/j.thromres.2014.06.007

Cited by 29 publications

(27 citation statements)

References 25 publications

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“…Shear flow-related mechanisms of SMPA are likely to have predominant implications in the development of thromboembolic complications in patients implanted with mechanical therapeutic BRDs 13–15 , which contribute significantly to overall morbidity and mortality 16, 17 .…”

Section: Introductionmentioning

confidence: 99%

High Frequency Components of Hemodynamic Shear Stress Profiles are a Major Determinant of Shear-Mediated Platelet Activation in Therapeutic Blood Recirculating Devices

Consolo

Sheriff

Gorla

et al. 2017

Sci Rep

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We systematically analyzed the relative contributions of frequency component elements of hemodynamic shear stress waveforms encountered in cardiovascular blood recirculating devices as to overall platelet activation over time. We demonstrated that high frequency oscillations are the major determinants for priming, triggering and yielding activated “prothrombotic behavior” for stimulated platelets, even if the imparted shear stress has low magnitude and brief exposure time. Conversely, the low frequency components of the stress signal, with limited oscillations over time, did not induce significant activation, despite being of high magnitude and/or exposure time. In vitro data were compared with numerical predictions computed according to a recently proposed numerical model of shear-mediated platelet activation. The numerical model effectively resolved the correlation between platelet activation and the various frequency components examined. However, numerical predictions exhibited a different activation trend compared to experimental results for different time points of a stress activation sequence. With this study we provide a more fundamental understanding for the mechanobiological responsiveness of circulating platelets to the hemodynamic environment of cardiovascular devices, and the importance of these environments in mediating life-threatening thromboembolic complications associated with shear-mediated platelet activation. Experimental data will guide further optimization of the thromboresistance of cardiovascular implantable therapeutic devices.

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Section: Introductionmentioning

confidence: 99%

High Frequency Components of Hemodynamic Shear Stress Profiles are a Major Determinant of Shear-Mediated Platelet Activation in Therapeutic Blood Recirculating Devices

Consolo

Sheriff

Gorla

et al. 2017

Sci Rep

View full text Add to dashboard Cite

show abstract

“…All had aggravating factors that should have been considered. The data of hemorrhagic events range from 4.6 to 15.4 events/100 patients/year and embolic event contents ranged from 0.75 to 2.57 events/100 patients/year (Labaf et al, 2014;Pastori et al, 2015). These data demonstrate the need for greater monitoring of this drug, considering it's chronic use and that the adverse events could be avoided.…”

Section: Discussionmentioning

confidence: 88%

“…Adverse events arising from interactions range from small bleeds to severe bleeding, requiring hospitalizations (Simon et al, 2016). The incidence of bleeding ranges from 4.6 to 15.4 reactions/100 patients/year, whereas embolic events range from 0.75 to 2.57 reactions/100 patients/year (Cressman et al, 2015;Labaf et al, 2014;Benhamou et al, 2009;Pastori et al, 2015). Warfarin is the oral anticoagulant of choice in the Brazilian public health system (Brazil, 2017).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic itinerary: trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Colet

Amador

Heineck

2018

Braz. J. Pharm. Sci.

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Warfarin is the most used anticoagulant in primary health care. Due to the narrow therapeutic index, its users are more susceptible to adverse events. The objective of this study was to describe the itinerary of the public health sector patients for resolution of adverse events related to warfarin. It is a prospective open cohort, held for a period of 18 months with warfarin users of the Brazilian public health system. Data were collected by monthly interviews and from patient records. Results: Sixty nine patients were interviewed, 64 of them completed monitoring and five died. Bleeding and venous thromboembolism were more frequent in patients starting treatment. It was observed that when adverse events have occurred, in most cases the patient held self-care at home (57%). During the follow-up, five patients were hospitalized for bleeding. Approximately half of the patients did not present their INR exams to the doctor. Conclusions: This study demonstrates weaknesses in caring for these patients and the need to accompany them, aiming to standardize and guide the itinerary of the anticoagulated patient to solve their problems and improve safety in drug treatment, with less cost to the public health system.

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“…Heart valve replacement has been associated with cerebral ischemia. Thromboembolisms in patients with valve replacements have been approximated to be 1% per patient-year with cerebrovascular event history recognized as a risk factor for TE and hemorrhagic complications [ 28 , 29 , 30 , 31 ]. As mentioned above, anticoagulation decreases the risk of TE in patients with an MHV; however, the risk of thromboembolism is significantly increased with the use of an MHV as compared to bioprosthetic valves.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Hemorrhagic Conversion of Ischemic Stroke in a Patient with Mechanical Heart Valve: A Case Report and Literature Review

2018

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The authors present a unique case of recurrent stroke, discovered to be secondary to hemorrhagic conversion of microemboli from a mechanical aortic valve despite anticoagulation with Coumadin. The complexity of this case was magnified by the patient’s young age, a mechanical heart valve (MHV), and a need for anticoagulation to maintain MHV patency in a setting of potentially life-threatening intracranial hemorrhage. Anticoagulant and antiplatelet therapy are risk factors for hemorrhagic conversion post-cerebral ischemia; however, the pathophysiology underlying endothelial cell dysfunction causing red blood cell extravasation is an active area of basic and clinical research. The need for randomized clinical trials to aid in the creation of standardized treatment protocol continues to go unmet. Consequently, there is marked variation in therapeutic approaches to treating intracranial hemorrhage in patients with an MHV. Unfortunately, patients with an MHV are considered at high thromboembolic (TE) risk, and these patients are often excluded from clinical trials of acute stroke due to their increased TE potential. The authors feel this case represents an example of endothelial dysfunction secondary to microthrombotic events originating from an MHV, which caused ischemic stroke with hemorrhagic conversion complicated by the need for anticoagulation for an MHV. This case offers a definitive treatment algorithm for a complex clinical dilemma.

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Thromboembolism, major bleeding and mortality in patients with mechanical heart valves- a population-based cohort study

Cited by 29 publications

References 25 publications

High Frequency Components of Hemodynamic Shear Stress Profiles are a Major Determinant of Shear-Mediated Platelet Activation in Therapeutic Blood Recirculating Devices

High Frequency Components of Hemodynamic Shear Stress Profiles are a Major Determinant of Shear-Mediated Platelet Activation in Therapeutic Blood Recirculating Devices

Therapeutic itinerary: trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Recurrent Hemorrhagic Conversion of Ischemic Stroke in a Patient with Mechanical Heart Valve: A Case Report and Literature Review

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