Alternatives for Vitamin K Antagonists as Thromboprophylaxis for Mechanical Heart Valves and Mechanical Circulatory Support Devices: A Systematic Review

Omayra C.D. Liesdek; Rolf T. Urbanus; Linda M. de Heer; Kathelijn Fischer; Willem J.L. Suyker; Roger E.G. Schutgens

doi:10.1055/s-0041-1722846

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2021; 47(06): 724-734
DOI: 10.1055/s-0041-1722846

Review Article

Alternatives for Vitamin K Antagonists as Thromboprophylaxis for Mechanical Heart Valves and Mechanical Circulatory Support Devices: A Systematic Review

Authors

Omayra C.D. Liesdek

¹Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

²Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Rolf T. Urbanus

²Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Linda M. de Heer

¹Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Kathelijn Fischer

²Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Willem J.L. Suyker

¹Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Roger E.G. Schutgens

²Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

Abstract

The holy grail of anticoagulation in patients with intracardiac devices, such as mechanical heart valves (MHVs) and left ventricular assist devices (LVADs), comprises safe prevention of thrombosis without interrupting normal hemostasis. Device-induced thrombosis and anticoagulant-related bleeding problems are dreaded complications that may cause a significantly reduced quality of life and increased morbidity and mortality. Vitamin K antagonists are the current standard for oral anticoagulation therapy in patients with MHVs and LVADs. Even within the therapeutic range, hemorrhage is the primary complication of these drugs, which emphasizes the need for safer anticoagulants for the prevention of device-induced thrombosis. Device-induced thrombosis is a complex multifactorial phenomenon that likely requires anticoagulant therapy targeting multiple pathways. Here, we review the preclinical and clinical data describing the efficacy of a variety of anticoagulants as thromboprophylaxis after implantation of intracardiac devices.

Keywords

mechanical heart valve - mechanical circulatory support - non-VKA anticoagulation - thromboprophylaxis

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Referenzen

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