Antithrombotic therapy after heart valve intervention: a review of mechanisms, evidence and current guidance
Mar 12, 2024
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Cardiac surgeon Norman Briffa discusses anti-thrombotic strategies post valve intervention, exploring challenges and guidelines. They delve into thrombus formation on valve prostheses, personalized anticoagulation therapy, and the challenges of NOACs for patients with mechanical heart valves.
Understanding different anti-coagulation needs for mechanical and bioprosthetic heart valves post intervention.
Recognizing diverse mechanisms leading to thrombus formation in heart valves, influenced by valve type and environmental factors.
Deep dives
Importance of Reviewing Antithrombotic Therapy After Valve Intervention
The podcast delves into the significance of reviewing antithrombotic therapy after valve intervention, highlighting the increasing number of patients undergoing heart valve interventions, both surgically and transcatheter procedures. With a surge in valve repairs and replacements, understanding the various types of heart valve interventions becomes crucial due to the multitude of available anti-coagulants and anti-platelet agents, making it a topic of paramount importance.
Thrombus Formation on Valve Prostheses and Risk Factors
The discussion focuses on the mechanisms leading to thrombus formation on valve prostheses, elucidating that thrombus initiation is through intrinsic pathways of the coagulation cascade. Factors like subendothelial collagen exposure, foreign surfaces, and activated platelets contribute to thromboembolic risks in heart valve devices. Differences in thromboembolic risks exist between mitral and aortic valves, emphasizing how shear stress and blood velocity impact the occurrence of thrombus formation.
Management of Mechanical and Bioprosthetic Heart Valves
The podcast highlights the guidelines for managing mechanical and bioprosthetic heart valves, emphasizing the critical need for understanding anti-coagulation requirements. For mechanical valves, maintaining an INR range of 2-3 is a starting point, with deviations based on specific patient risk factors. In contrast, bioprosthetic valves have specific anti-coagulation requirements immediately post-implantation, with ongoing strategies based on patient risk, valve position, and rhythm disturbances.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Norman Briffa, a cardiac surgeon from Sheffield, UK. They discuss his review paper about anti-thrombotic strategies after valve intervention, both transcatheter and surgical. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.