ABC of antithrombotic therapy: Valvar heart disease and prosthetic heart valves

doi:10.1136/bmj.325.7374.1228

BMJ 2002;325:1228-1231 ( 23 November )

Clinical review

ABC of antithrombotic therapy

Valvar heart disease and prosthetic heart valves

Ira Goldsmith, Alexander G G Turpie, Gregory Y H Lip.

The first 150 words of the full text of this article appear below.

Thromboembolism and anticoagulant related bleeding are major life threatening complications in patients with valvar heartdisease and those with prosthetic heart valves. In these patientseffective and safe antithrombotic therapy is indicated to reducethe risks of thromboembolism while keeping bleeding complicationsto a minimum.

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Assessment

Risk factors that increase the incidence of systemic embolism must be considered when defining the need for starting antithrombotictherapy in patients with cardiac valvar disease and prostheticheart valves. These factors include age, smoking, hypertension,diabetes, hyperlipidaemia, type and severity of valve lesion,presence of atrial fibrillation, heart failure or low cardiacoutput, size of the left atrium (over 50 mm on echocardiography),previous thromboembolism, and abnormalities of the coagulationsystem including hepaticfailure.

Secondly, the type, number, and location of prostheses implanted must be considered. For example, mechanical prostheses aremore thrombogenic than bioprostheses or homografts, and hencepatients with mechanical valves require lifelong . . . [Full text of this article]

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