Successful Long‐term Anticoagulation with Enoxaparin in a Patient with a Mechanical Heart Valve

Abstract

Thromboembolism related to a mechanical heart valve (MHV) is a major complication after surgical valve replacement. Warfarin remains as guideline-endorsed thromboprophylaxis in patients with MHVs. Alternative anticoagulation therapy for patients who do not tolerate or who fail warfarin is not adequately covered in the current guidelines. We report a case of successful long-term anticoagulation with enoxaparin in a patient with a mechanical aortic valve who had a contraindication to warfarin. The patient developed a left thigh hematoma requiring surgical evacuation 1 month after initiation of weight-based dosing of enoxaparin. His dose was then titrated based on peak anti-factor Xa levels (goal 0.6-1.0 IU/ml). He remained free of signs and symptoms of thromboembolic events, valve dysfunction, bleeding complications, or major adverse effects from long-term enoxaparin use for the next 13 years. Our case provides promising evidence of the potential role of enoxaparin in patients with MHVs in whom warfarin thromboprophylaxis is not possible. Meticulous monitoring of anti-factor Xa levels and dosage adjustments are crucial to treatment success.

Successful Long-term Anticoagulation with Low Molecular Weight Heparin in a Patient with Mechanical Mitral Valve and Atrial Flutter

“…The temporary use of LMWH in patients with MHV without pregnancy is limited to case reports and few prospective non-randomized data [ 9 ]. There is a single case report of long-term anticoagulation with LMWH in a patient with a mechanical aortic valve [ 10 ]. It is worth noting that the aortic valve position is associated with the lowest risk of thrombosis in cases of MHV.…”