The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies
DOI:
https://doi.org/10.1532/hsf.1348Abstract
Background: It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement.Methods: We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
Results: For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
Conclusion: The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
References
Akhtar RP, Abid AR, Zafar H, Khan JS. 2009. Aniticoagulation in patients following prosthetic heart valve replacement. Ann Thorac Cardiovasc Surg 15:10-7.
Badami KG. 2014. An update of consensus guidelines for warfarin reversal. Med J Australia 200:80.
Barwad P, Raheja A, Venkat R, Kothari SS, Bahl V, Karthikeyan G. 2012. High prevalence of silent brain infarction in patients presenting with mechanical heart valve thrombosis. Am J Cardiovasc Drugs 12:345-8.
Becattini C, Agnelli G, Schenone A, et al. 2012. Aspirin for preventing the recurrence of venous thromboembolism. New England J Med 366:1959-67.
Berger PB, Vedamurthy D, Casale A, et al. 2015. The risk of thromboembolic complications without anticoagulation after surgical aortic valve replacement with a bioprosthesis. J Am Coll Cardiol 65(10_S).
Bouglé A, Harrois A, Duranteau J. 2013. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care 3:1.
Brown ML, Park SJ, Sundt TM, Schaff HV. 2012. Early thrombosis risk in patients with biologic valves in the aortic position. The Journal of thoracic and cardiovascular surgery. 144:108-11.
Brunicardi F, Andersen D, Billiar T, et al. 2015. Anticoagulation and bleeding. Schwartz’s Principles of Surgery,10th ed.
Cannegieter SC, Rosendaal FR, Briët E. 1994. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89:635-41.
Cannegieter SC, Rosendaal FR, Wintzen AR, van der Meer FJ, Vandenbroucke JP, Briet E. 1995. Optimal oral anticoagulant therapy in patients with mechanical heart valves. New England J Med 333:11-7.
Chen BC, Viny AD, Garlich FM, et al. 2012. Hemorrhagic complications associated with dabigatran use. Clin Toxicol 50:854-7.
Cothren CC, Moore EE, Hedegaard HB, Meng K. 2007. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg 31:1507-11.
Crowther MA, Douketis JD, Schnurr T, et al. 2002. Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy: a randomized, controlled trial. Ann Int Med 137:251-4.
Floccard B, Rugeri L, Faure A, et al. 2012. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury 43:26-32.
Gualdo JC, Fernandez DB, Serra JT, Hernández JT, Vicente DP, Alemany RM. 2013. Pelvic fractures in polytrauma: which classification system better predicts hemodynamic instability? Eur Orthopaed Trauma 4:35-9.
Harper P, Young L, Merriman E. 2012. Bleeding risk with dabigatran in the frail elderly. New England J Med 366:864-6.
Hering D, Piper C, Bergemann R, et al. 2005. Thromboembolic and bleeding complications following St. Jude Medical valve replacement: results of the German experience with low-intensity anticoagulation study. Chest 127:53-9.
Jegaden O, Eker A, Delahaye F, et al. 1994. Thromboembolic risk and late survival after mitral valve replacement with the St. Jude Medical valve. Ann Thorac Surg 58:1721-7.
Lind S, Callas P, Golden E, Joyner Jr K, Ortel T. 1997. Plasma levels of factors II, VII and X and their relationship to the international normalized ratio during chronic warfarin therapy. Blood Coagulation & Fibrinolysis 8:48-53.
Marie I, Leprince P, Menard J-F, Tharasse C, Levesque H. 2012. Risk factors of vitamin K antagonist overcoagulation. QJM 105:53-62.
Matityahu A, Marmor M, Elson JK, et al. 2013. Acute complications of patients with pelvic fractures after pelvic angiographic embolization. Clin Orthopaed Rel Res 471:2906-11.
Mauffrey C, Cuellar III D, Pieracci F, et al. 2014. Strategies for the management of haemorrhage following pelvic fractures and associated trauma-induced coagulopathy. Bone & Joint. 96:1143-54.
Mérie C, Køber L, Olsen PS, et al. 2012. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA 308:2118-25.
Mitra B, Cameron PA, Mori A, Fitzgerald M. 2012. Acute coagulopathy and early deaths post major trauma. Injury 43:22-5.
Moeinipour AA, Shamlou AS, Lotfalizadeh M, Esfahanizadeh J,
Mottahedi B, Hoseinikhah H. 2015. Evaluation of last guidelines and studies about the best treatment with anticoagulant during pregnancy in woman with mechanical heart valves. Iranian J Obstetrics Gynecology Infertility 18:15-9.
Nishimura RA, Warnes CA. 2015. Anticoagulation during pregnancy in women with prosthetic valves: evidence, guidelines and unanswered questions. Heart heartjnl-2014-306500.
Okamura H, Yamaguchi A, Nagano H, et al. 2012. Mid-term outcomes after aortic valve replacement with the 17-mm St. Jude Medical Regent valve. Circulation 76:365-71.
O’Neal P, Moore Jr F, Gawande A, Cho N, Moalem J, Ruan D. 2012. Hemorrhagic shock as the initial manifestation of pheochromocytoma: report of a sequential management strategy. Endocrine Practice 18:e81-e4.
Panduranga P, Al-Mukhaini M, Al-Muslahi M, Haque MA, Shehab A. 2012. Management dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding. World J Cardiol 4:54.
Pernod G, Godier A, Gozalo C, Tremey B, Sie P. 2010. French clinical practice guidelines on the management of patients on vitamin K antagonists in at-risk situations (overdose, risk of bleeding, and active bleeding). Thrombosis Research 126:e167-74.
Roudaut R, Serri K, Lafitte S. 2007. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart 93:137-42.
Spahn DR, Bouillon B, Cerny V, et al. 2013. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 17:R76.
Steiner T, Böhm M, Dichgans M, et al. 2013. Recommendations for the emergency management of complications associated with the new direct oral anticoagulants (DOACs), apixaban, dabigatran and rivaroxaban. Clin Res Cardiol 102:399-412.
Tonolini M, Ippolito S, Patella F, Petullà M, Bianco R. 2012. Hemorrhagic complications of anticoagulant therapy: role of multidetector computed tomography and spectrum of imaging findings from head to toe. Current problems in diagnostic radiology 41:233-47.
Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. 2013. An update of consensus guidelines for warfarin reversal. Med J Aust 198:198-9.
Tran HA, Chunilal SD, Tran H. 2014. An update of consensus guidelines for warfarin reversal. Medical J Australia 200:82.
Vaidya R, Kubiak EN, Bergin PF, et al. 2012. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthopaed Rel Res 470:2124-31.
Ziran NM, Smith WR. 2014. Pelvic fractures. Management of musculoskeletal injuries in the trauma patient: Springer; p.143-63.
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