Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves cared for in a tertiary care center. What have we learned?

Autor:	Sánchez-Medina FF; Department of Cardiothoracic Surgery, Centro Médico Nacional del Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora., Valenzuela-Antelo O; Department of Health Sciences, Universidad de Sonora, Hermosillo, Sonora., Valenzuela-Molina LC; Intensive Care Unit, Centro Médico Nacional del Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora., Arias-Martínez J; Department of Health Sciences, Universidad de Sonora, Ciudad Obregón, Sonora., López-Morales CM; Department of Family Medicine, Delegación Estatal del Instituto Mexicano del Seguro Social, Mexicali, Baja California. Mexico., Ornelas-Aguirre JM; Department of Health Sciences, Universidad de Sonora, Ciudad Obregón, Sonora.
Jazyk:	angličtina
Zdroj:	Gaceta medica de Mexico [Gac Med Mex] 2023; Vol. 159 (3), pp. 210-218.
DOI:	10.24875/GMM.M23000772
Abstrakt:	Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy. (Copyright: © 2023 Permanyer.)
Databáze:	MEDLINE
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