Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Abstract

Purpose Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Followup care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. Methods A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. Results The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. Conclusions Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.

Mechanical Prosthetic Valve Thrombus in a Term Pregnant Woman Presenting as Acute Heart Failure: Case Report and Review of Literature

“…The risk of fetal loss including miscarriage, embryopathy, and fetal death increases when the woman is on VKA throughout the pregnancy. 2 3 4 5 6 The usage of VKA in first trimester was associated with greater risk of miscarriage compared with heparin (28.6 vs. 9.2% p < 0.001). Unlike heparin, there is a risk of fetoplacental transfer with VKA; however, the fetal effects are dose dependent.…”

“…Generally, whenever valve replacement is needed in young women, MPHV is preferred over bioprosthetic valve because of durability and its ability to withstand the hemodynamics of pregnancy. 2 3 4 However, they need lifelong anticoagulation with oral VKA.…”

“…Though pregnancy-associated myocardial infarction (PAMI) and aortic dissection are the common causes of adverse cardiac events in developed countries, rheumatic heart diseases (RHDs) continue to be the important reason for cardiovascular morbidity and mortality in emerging countries. 1 2 The risk of adverse cardiac outcome is dependent on the type and severity of valvular abnormality, functional status, left ventricular function, and pulmonary arterial pressure. 2 3 Managing a pregnant woman with mechanical prosthetic heart valve (MPHV) is challenging because of the difficulty in achieving optimal anticoagulation in the presence of hypercoagulability.…”

“…1 2 The risk of adverse cardiac outcome is dependent on the type and severity of valvular abnormality, functional status, left ventricular function, and pulmonary arterial pressure. 2 3 Managing a pregnant woman with mechanical prosthetic heart valve (MPHV) is challenging because of the difficulty in achieving optimal anticoagulation in the presence of hypercoagulability. Due to different maternal and fetal risks associated with anticoagulation, along with absence of randomized controlled trials, the optimal anticoagulation regimen in pregnant women remains uncertain.…”

The of effect of partnership-based education on adherence to the treatment plans in open heart surgery

“…[ 2 ] There is evidence indicating that mortality rate due to CVDs has remarkably been decreased during the past 5–10 years as a result of pharmaceutical developments and surgery methods such as thrombolytic therapy, coronary artery bypass graft (CABG), valve repair, or replacement surgeries. [ 3 ]…”