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Erschienen in: Journal of Thrombosis and Thrombolysis 3/2019

17.12.2018

Thromboembolism and bleeding in patients with cancer and mechanical heart valves

verfasst von: Andrea Plaja, Elisabet Berastegui, Javier Nieto-Moragas, Edurne Sarrate, Francisco Gual-Capllonch, Vanesa Quiroga, Marc Sorigue

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 3/2019

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Abstract

Mechanical heart valves (MHV) require life-long anticoagulation with vitamin K antagonists (VKA), but anticoagulation management is complex in patients with cancer due to a high risk of thrombosis and bleeding. This is a retrospective, single-center study to assess anticoagulation management and thrombotic (stroke/valve thrombosis) and bleeding events in patients with active cancer and MHV. The incidence of thrombotic complications was compared to a control group (matched 1:1) of patients with MHV but without cancer. We included 48 patients, 60% of whom had aortic prostheses, 23% mitral prostheses and 17% both types. All patients received VKA as anticoagulant. With a median follow-up of 5.12 years, we observed two arterial thrombotic events (two strokes and no heart valve thrombosis). The 5-year incidence (95% confidence interval [CI]) of stroke/valve thrombosis was 5.7% (0.9–17.9%). The control group had a similar incidence of stroke/valve thrombosis (5-year incidence 7.9% [95%CI 2–19.8], p = 0.16). There were also 15 major bleeding episodes in the cancer group, 11 of which were related to a surgical procedure. The 5-year incidence (95% CI) of major bleeding was 32.9% (18.5–48%), and that of major bleeding unrelated to any procedure was 10.3% (3–23%). We found a low incidence of thrombotic events in this series of patients with active cancer and MHV who were anticoagulated with VKA. However, the incidence of bleeding was high, particularly in relation to invasive procedures.
Literatur
5.
Zurück zum Zitat Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients, J Thromb Haemost 3:692–694. https://doi.org/10.1111/j.1538-7836.2005.01204.x CrossRef Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients, J Thromb Haemost 3:692–694. https://​doi.​org/​10.​1111/​j.​1538-7836.​2005.​01204.​x CrossRef
9.
Zurück zum Zitat Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2017) American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2017 update of 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 63:e57–e185. https://doi.org/10.1016/j.jacc.2014.02.536 CrossRef Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2017) American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2017 update of 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 63:e57–e185. https://​doi.​org/​10.​1016/​j.​jacc.​2014.​02.​536 CrossRef
12.
Zurück zum Zitat Puskas J, Gerdisch M, Nichols D, Quinn R, Anderson C, Rhenman B, Fermin L, McGrath M, Kong B, Hughes C, Sethi G, Wait M, Martin T, Graeve A, Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized food and drug administration investigational device exemption trial. J Thorac Cardiovasc Surg 147 (2014). https://doi.org/10.1016/j.jtcvs.2014.01.004 Puskas J, Gerdisch M, Nichols D, Quinn R, Anderson C, Rhenman B, Fermin L, McGrath M, Kong B, Hughes C, Sethi G, Wait M, Martin T, Graeve A, Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized food and drug administration investigational device exemption trial. J Thorac Cardiovasc Surg 147 (2014). https://​doi.​org/​10.​1016/​j.​jtcvs.​2014.​01.​004
18.
Zurück zum Zitat Hammerstingl C, Tripp C, Schmidt H, von der Recke G, Omran H (2007) Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. J Heart Valve Dis 16:285–292PubMed Hammerstingl C, Tripp C, Schmidt H, von der Recke G, Omran H (2007) Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry. J Heart Valve Dis 16:285–292PubMed
Metadaten
Titel
Thromboembolism and bleeding in patients with cancer and mechanical heart valves
verfasst von
Andrea Plaja
Elisabet Berastegui
Javier Nieto-Moragas
Edurne Sarrate
Francisco Gual-Capllonch
Vanesa Quiroga
Marc Sorigue
Publikationsdatum
17.12.2018
Verlag
Springer US
Erschienen in
Journal of Thrombosis and Thrombolysis / Ausgabe 3/2019
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-018-1790-3

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