alexa Oral Anticoagulation after Mechanical Heart Valve Replacement: Low Intensity Regimen can Make the Difference
ISSN: 2155-9880

Journal of Clinical & Experimental Cardiology
Open Access

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Review Article

Oral Anticoagulation after Mechanical Heart Valve Replacement: Low Intensity Regimen can Make the Difference

Michele Torella1*, Daniele Torella2, Gianantonio Nappi1, Paolo Chiodini3, Marco Torella4 and Luca Salvatore De Santo5
1Department of Cardio-Thoracic Sciences, Second University of Naples, Naples, Italy
2Molecular and Cellular Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
3Department of Medicine and Public Health, Second University of Naples, Naples, Italy
4Department of Gynaecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
5Department of Medical and Surgical Sciences, Chair of Cardiac Surgery, University of Foggia, Foggia, Italy - Casa di Cura Montevergine, Avellino, Italy
Corresponding Author : Michele Torella
Second University of Naples
Department of Cardiothoracic sciences, Naples, Italy
Tel: +390817062521
E-mail: [email protected]
Received April 17, 2014; Accepted May 22, 2014; Published June 05, 2014
Citation: Torella M, Torella D, Nappi G, Chiodini P, Torella M, et al. (2014) Oral Anticoagulation after Mechanical Heart Valve Replacement: Low Intensity Regimen can Make the Difference. J Clin Exp Cardiolog 5:319. doi:10.4172/2155-9880.1000319
Copyright: © 2014 Torella M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Despite continuous improvement in the field, the ideal prosthetic heart valve remains to be developed. Patients with mechanical prosthetic heart valves are at risk of thrombosis and systemic embolism. The incidence rate of these serious complications is significantly reduced by lifelong Oral Anticoagulant Therapy (OAC) vitamin K antagonist (VKA) therapy. Despite its undeniable benefits, VKA therapy with warfarin is affected by a number of known limitations, including bleeding complications, dietary and drug interactions, and need for international normalized ratio (INR) monitoring and dose adjustments. In particular, the optimal intensity of anticoagulant therapy remains a delicate equilibrium and continues to be an ongoing matter of debate. A significant number of trials has been published on this topic. In this review article we review the pathogenesis of OAC related complications, the evidences supporting current recommendations along with the results of major prospective randomised trials on low intensity OAC regimens and self-management. Safe and effective chronic OAC therapy after mechanical valve replacement requires a thorough examination of patients’ features, optimal surgical techniques, state of the art definition of target INR levels and close surveillance. Based on our and other work, we argue that low-dose anticoagulation is safe and feasible in selected mechanical valve recipients and also it may be of benefit during pregnancy. Concurrently, evidence from most recent reports highlights that even higher risk patients’ subsets may profit from low intensity protocols. These data postulate that low intensity regimen of OAC coupled with close INR monitoring can make a significant difference for low to intermediate risk patients with aortic mechanical valve replacement.

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