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Antithrombotic therapy in patients with prosthetic heart valves

INTRODUCTION

Among patients who undergo cardiac valve replacement, approximately 60 percent receive mechanical valves composed of carbon alloys with a tilting disk or bileaflet design. The remaining 40 percent receive bioprosthetic valves, which may be heterografts (primarily porcine or bovine tissue), homografts (preserved human aortic valves), or pulmonary autografts (table 1).

Replacement of a diseased heart valve with a prosthetic valve exchanges the native disease for potential prosthesis-related complications. The frequency of serious complications depends upon the valve type and position, and other clinical risk factors.

Thromboembolic and anticoagulation-related problems are by far the most frequent complications of mechanical valves. In contrast, structural failure is relatively rare with these prostheses compared to bioprosthetic valves. Other major complications of prosthetic heart valves include endocarditis, paravalvular leak, and hemolysis. The complications as well as valve obstruction and valve thrombosis are discussed separately. (See "Complications of prosthetic heart valves".)

There are five main issues the clinician must face in managing the patient with a prosthetic heart valve:

  • Antithrombotic therapy to prevent valve thrombosis and thromboembolism
  • Evaluation of valve function and durability
  • Endocarditis prophylaxis
  • Safety of exercise
  • Pregnancy

                             

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Literature review current through: 20.6: May 2012
This topic last updated: Jun 15, 2011
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