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Gaceta médica de México
On-line version ISSN 2696-1288Print version ISSN 0016-3813
Abstract
SANCHEZ-MEDINA, Fernando F. et al. Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves at third level care center. What have we learned?. Gac. Méd. Méx [online]. 2023, vol.159, n.3, pp.215-223. Epub June 12, 2023. ISSN 2696-1288. https://doi.org/10.24875/gmm.22000373.
Background:
Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications.
Objective:
To determine the complications related to complementary anticoagulation therapy and the probability of risk.
Methods:
One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded.
Results:
In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001).
Conclusions:
Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.
Keywords : Bleeding complications; Thromboembolic complications; Structural valve deterioration; Heart valve prostheses; Anticoagulation therapy; Prosthetic valve thrombosis.