LOW-MOLECULAR-WEIGHT HEPARIN TREATMENT FAILURE IN PREVENTION OF PROSTHETIC MITRAL VALVE THROMBOSIS
2009
Background Prosthetic heart valve thrombosis (PHVT) represents a dangerous postoperative complication following prosthetic heart valve replacement. Incidence varies according to different data from 0.5–4 % per year following mitral or aortic valve replacement in spite of
adequate oral anticoagulation with coumarins.
Case report We are presenting a case of prosthetic mitral valve thrombosis as a result of 6-month lowmolecular-weight heparin (LMWH) (nadroparine) treatment failure. Our patient presented with clinical picture of massive and recurrent bilateral pleural effusions and sub
sequent development of acute left-sided heart failure. Diagnosis was made with transesophageal ultrasound examination. The patient underwent surgical thrombectomy and recovered completely. He died a month later because of pneumonia with septic complications and multiorgan failure.
Conclusions Our case raises suspicion that the use of LMWHs as an alternative anticoagulant for
long-term antithrombotic prophylaxis in patients with prosthetic heart valves carries an
increased risk of PHVT. There is a lack of larger randomised trials comparing the safety of
LMWH and coumarin anticoagulation in patients with prosthetic heart valves.
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