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

Dattilo, Giuseppe; Tulino, Domenico; Lamari, Annalisa; Tulino, Viviana; Marte, Filippo; Patanè, Salvatore

doi:10.1016/j.ijcard.2008.12.180

Cited by 13 publications

(8 citation statements)

References 6 publications

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“…Our survey of pediatric practitioners reflected current era practice demonstrating a persistent tendency toward more conservative perioperative anticoagulation management. This may be due to poor penetration of adult data demonstrating lower TE risks in newer generations of prosthetic valves, safety and efficacy of LMWH as a perioperative bridging agent, and recent AHA/ACCP guidelines . Additional barriers toward adoption of guideline recommendations may be due to the lack of high‐quality Level‐1 evidence or local resources constraints, which prohibit implementation of changes in practice .…”

Section: Discussionmentioning

confidence: 99%

Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves

Nguyen

Sharathkumar

2015

Congenit Heart Dis

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This was the first documentation that clinical practice of bridging perioperative anticoagulation in children with mechanical heart valves varies widely among pediatric cardiac specialists. There is poor adoption of published guidelines and a tendency toward more conservative strategies. Further studies comparing the safety and efficacy of LMWH vs. UFH as perioperative anticoagulation agents in children with mechanical heart valves are needed to further clarify our findings. Quality assurance initiatives and education are also needed to improve guidelines adherence and standardize practice management.

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Section: Discussionmentioning

confidence: 99%

Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves

Nguyen

Sharathkumar

2015

Congenit Heart Dis

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“…Despite the absence of approval for use in patients with MHVs, LMWHs are considered to be a treatment option in guidelines for periprocedural bridging treatment [9]. These drugs should be given subcutaneously twice daily, with the use of body weight-adjusted therapeutic doses and anti-FXa activity monitoring, with target levels ranging from 0.5 to 1.0 U mL À1 [8].…”

Section: Discussionmentioning

confidence: 99%

“…The lack of randomized clinical trials (RCTs), together with some published reports with inconclusive and contradictory findings, have raised doubts about the safety and efficacy of LMWHs in patients with MHVs [6][7][8][9][10]. The European Society of Cardiology Guidelines consider both UFH and LMWHs as treatment options for postsurgery use in patients with MHVs and for those undergoing surgical or diagnostic procedures needing bridging anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of low molecular weight heparin in patients with mechanical heart valves: systematic review and meta‐analysis

Caldeira

David

Santos

et al. 2014

Journal of Thrombosis and Haemostasis

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To cite this article: Caldeira D, David C, Santos AT, Costa J, Pinto FJ, Ferreira JJ. Efficacy and safety of low molecular weight heparin in patients with mechanical heart valves: systematic review and meta-analysis. J Thromb Haemost 2014; 12: 650-9.Summary. Background: Low molecular weight heparins (LMWHs) are not approved for patients with mechanical heart valves (MHVs). However, in several guidelines, temporary LMWH off-label use in this clinical setting is considered to be a valid treatment option. Therefore, we reviewed the efficacy and safety of LMWHs in patients with MHVs. Methods: MEDLINE and CENTRAL databases were searched from inception to June 2013. Review articles and references were also searched. We included experimental and observational studies that compared LMWHs with unfractionated heparin (UFH) or vitamin K antagonists (VKAs). Data were analyzed and pooled to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for thromboembolic and major bleeding events. Statistical heterogeneity was evaluated with the I 2 -test. Results: Nine studies were included: one randomized controlled trial (RCT) and eight observational studies, with a total of 1042 patients. No differences were found between LMWHs and UFH/VKAs in the risk of thromboembolic events (OR 0.67; 95% CI 0.27-1.68; I 2 = 9%) or major bleeding events (OR 0.66; 95% CI 0.36-1.19; I 2 = 0%). Conclusions: The best evidence available might support the temporary use of LMWHs as a prophylactic treatment option in patients with MHVs. However, conclusions are mostly based on observational data (with large CIs), and an adequately powered RCT is urgently needed in this clinical setting.

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“…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]. From time to time, it may be necessary to interrupt oral anticoagulant therapy in preparation for elective surgical procedures.…”

mentioning

confidence: 99%

“…Thrombus is a dangerous problem for the clinician [1][2][3]. In cardiac surgery, after mechanical heart valve replacement use of unfractionated heparin is sometimes required because vitamin K antagonists are temporarily contraindicated [4]or to prevent valve-associated thromboembolism until oral vitamin K antagonists take effect [5].…”

mentioning

confidence: 99%

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

Patanè¹,

Marte²,

Risica³

et al. 2009

International Journal of Cardiology

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

Cited by 13 publications

References 6 publications

Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves

Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves

Efficacy and safety of low molecular weight heparin in patients with mechanical heart valves: systematic review and meta‐analysis

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

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