Major Hemorrhagic and Thromboembolic Complications in Patients with Mechanical Heart Valves Receiving Oral Anticoagulant Therapy

  • Przemys?aw Trzeciak
  • Marian Zembala
  • Lech Polo?ski


Introduction: Patients with mechanical heart valve prostheses are obligated to receive lifelong oral anticoagulant therapy to prevent thromboembolic complications; however, this treatment is associated with an increased risk of bleeding. The aim of this study was to evaluate the frequency of major hemorrhagic and thromboembolic complications in patients with mechanical heart valves who received oral anticoagulant therapy.

Materials and Methods: The analysis involved 225 patients who underwent successful surgery in 2000; the mean (±SD) follow-up period was 43.3 ± 9.2 months. Aortic, mitral, and double valve replacement was performed in 128 (56.7%), 70 (31.1%), and 27 (12.1%) of the patients, respectively. There were 128 men (57.3%), and the mean patient age was 57.9 ± 18.8 years. The following data were assessed: rate of major hemorrhagic and thromboembolic complications, frequency of international normalized ratio (INR) rate measurements, and percentage of results within the therapeutic range.

Results: Major hemorrhagic and thromboembolic complications occurred in 25 patients (11.1%). Seventeen patients (7.5%) survived, and 8 (3.6%) died of the complications. Major hemorrhagic and thromboembolic complications occurred in 17 patients (7.6%) and 8 patients (3.6%), respectively. The mean time between sequential measurements was 4.3 ± 3.0 weeks, and of all the INR values collected, 42.4% were within, 31.3% were below, and 26.3% were above the target ranges.

Conclusions: Patients with a mechanical heart valve prosthesis receiving acenocoumarol are susceptible to major hemorrhagic and thromboembolic complications, some of which lead to death. Despite the danger related to these complications, patients receiving anticoagulant therapy still have difficulty achieving INR values within the therapeutic range.


Acar J, Jung B, Boissel JP, et al. 1996. AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves. Circulation 94:2107-12.\nAltman R, Rouvier J, Gurfinkel E, Scazziota A, Turpie AG. 1996. Comparison of high-dose with low-dose aspirin in patients with mechanical heart valve replacement treated with oral anticoagulant. Circulation 94:2113-6.\nAnsell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. 2004. The pharmacology and management of the vitamin K antagonists. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:204S-33S.\nAris A, Igual A, Padro JM, et al. 1996. The Spanish Monostrut Study Group: a ten year experience with 8,599 implants. Ann Thorac Surg 62:40-7.\nBussey HL, Chiquette E, Amato M. 1996. Anticoagulation clinic care versus routine medical care: a review and interim report. J Thromb Thrombolysis 2:315-9.\nButchart EG, Gohlke-Barwolf C, Antunes MJ, et al. 2005. Recommendations for the management of patients after heart valve surgery. Eur Heart J 26:2463-71.\nButchart EG, Payne N, Li HH, Buchan K, Mandana K, Grunkemeier GL. 2002. Better anticoagulation control improves survival after valve replacement. J Thorac Cardiovasc Surg 123:715-23.\nCannegieter SC, Rosendal FR, Wintzen AR, van der Meer FJM, Vandenbroucke JP, Briet E. 1995. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 335:11-7.\nChiquette E, Amato MG, Bussey HI. 1998. Comparison of an anticoagulation clinic with usual medical care. Arch Intern Med 158:1644-7.\nCortelazzo S, Finazzi G, Viero P, Remuzzi A, Parenzan L, Barbui T. 1993. Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Thromb Haemost 69:316-20.\nDziatkowiak AJ. 2006. Outlined history of the development of the world and Polish cardiac surgery. J Physiol Pharmacol 57(suppl 1):43-105.\nFiore AC, Barner HB, Swartz MT, et al. 1998. Mitral valve replacement: randomized trial of St. Jude and Medtronic Hall prostheses. Ann Thorac Surg 66:707-13.\nHering 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.\nHorskotte D, Bergemann R, Althaus U, et al. 1993. German experience with low intensity anticoagulation (GELIA): protocol of a multi-center randomized, prospective study with the St. Jude Medical valve. J Heart Valve Dis 2:411-9.\nHorskotte D, Schulte H, Bircks W, Strauer B. 1993. Unexpected findings concerning thromboembolic complications and anticoagulation after complete 10 year follow up of patients with St. Jude prostheses. J Heart Valve Dis 2:291-301.\nLaffort P, Roudaist R, Rogues X, et al. 2000. Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the St. Jude medical prosthesis: a clinical and transesophageal echocardiographic study. J Am Coll Cardiol 35:739-46.\nLandefeld S. 1989. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144-52.\nLevine MN, Raskob G, Beyth RJ, Kearon C, Schulman S. 2004. Hemorrhagic complication of anticoagulant treatment. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(suppl):287S-310S.\nLink KP. 1959. The discovery of dicumarol and its sequels. Circulation 19:97-107.\nMassel D, Little S. 2001. Risks and benefits of adding anti-platelet therapy to warfarin among patients with prosthetic heart valves: a meta-analysis. J Am Coll Cardiol 37:569-78.\nMeschengieser SS, Fondevilla CG, Frontroth J, Santarelli MT, Lazzari MA. 1997. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg 113:910-6.\nPengo V, Barbero F, Banzato A, et al. 1997. A comparison of a moderate with moderate-high intensity oral anticoagulant treatment in patients with mechanical heart valve prostheses. Thromb Haemost 77:839-49.\n[Raport]Raport Klubu Kardiochirurgów Polskich. 2006. Kardiochir i Torakochir Pol 3:108-9.\nSaour JN, Sieck JO, Mamo LAR, Gallus AS. 1990. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med 322:428-32.\nTurpie AG, Gent M, Laupacis A, et al. 1993. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med 329:524-9.\n[VA]VA Cooperative Study Group on Valvular Heart Diseases. 1985. Prognosis in valvular heart disease. I. Description of purpose, organization, data collection techniques, estimates of statistical power and criteria for termination of patient entry. Control Clin Trials 6:51-74.\nVan Nooten GJ, Van Belleghem Y, Caes F, et al. 2003. Lower-intensity anticoagulation for mechanical heart valves: a new concept with the ATS bileaflet aortic valve. J Heart Valve Dis 12:495-502.\n
How to Cite
Trzeciak, P., Zembala, M., & Polo?ski, L. (2010). Major Hemorrhagic and Thromboembolic Complications in Patients with Mechanical Heart Valves Receiving Oral Anticoagulant Therapy. The Heart Surgery Forum, 13(2), E80-E85.

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