Anticoagulation in a Patient With Mechanical Prosthetic Valves and Calcific Uremic Arteriolopathy on Warfarin

Abstract

Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a rare vascular calcific disease that is most often associated with renal dysfunction and warfarin, particularly end-stage renal disease (ESRD). This condition causes debilitatingly painful skin lesions, oftentimes plaques, throughout areas of cutaneous and subcutaneous adiposity. The progression of these lesions to black eschar with ulceration is the hallmark of CUA. In this report, we present the case of a Caucasian female with a past medical history of nephrogenic systemic fibrosis (NSF), ESRD, and mechanical aortic and mitral valves, anticoagulated with warfarin, who developed CUA. In the setting of mechanical prosthetic valves, vitamin K antagonists (VKA) and aspirin are the only evidence-based antithrombotic therapies. This case presents challenging decision-making when managing anticoagulant therapy in the absence of applicable guidelines.

Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review

“…The clinical scenarios and prognosis of anticoagulation therapy in ESKD patients with calciphylaxis also vary from person to person ( Table 1 ). Some reported a significant clinical improvement after changing warfarin into unfractionated heparin [ 20 ] or enoxaparin [ 19 ], however, in some cases, the lesion still progressed even after the anticoagulation regimen was altered or halted [ 18–20 ]. Warfarin was proved to have a higher risk of all‐cause hospitalization in ESKD patients with AF [ 21 ], there is need to look for alternatives.…”