Impact of dengue-induced thrombocytopenia on mandatory anticoagulation for patients with prosthetic heart valves on warfarin

Bilateral rectus sheath haematoma complicating dengue virus infection in a patient on warfarin for mechanical aortic valve replacement: a case report

“…The point at which this has to be done should be decided on a case by case basis. The lowest threshold of absolute platelet count considered safe has varied, but usually lies between the range of 50 × 10 9 /L (150–450) to 100 × 10 9 /L (150–450) [5, 20]. The safe limit suggested to reinitiate anticoagulation is when platelet counts rise above 50 × 10 9 /L (150–450) [5, 20].…”

“…Foremost in the presence of life threatening bleeds, anticoagulation should be discontinued even in obligatory circumstances. In such situations anticoagulation has been discontinued as long as by a week, and sub-therapeutic levels have been maintained even further successfully with minimal thromboembolic risk [5]. Additionally the annual risk of thrombosis with mechanical valves even without anticoagulation is only 20% [8] and thus may justify the decision.…”

“…When complicated with single organ involvement, bleeding or compounded with the burden of managing additional co-morbidities requiring complex simultaneous management, takes an already challenging situation into unknown territory, with little in the way of evidence based guidance. The use or continuation of anticoagulation in mandatory situations is one such example and the lack of clear guidance with regard to anticoagulation in dengue management protocols and guidelines have been noted [5]. In this case vignette we present and discuss a patient who required lifelong anticoagulation due to mechanical aortic valve replacement who presented with dengue fever and suffered complicated bleeding which posed significant challenges in regard to clinical decisions and management.…”