Keywords
thromboembolic
hemorrhagic
cardiac surgery
sub-Saharan Africa
How to Cite
Abstract
Background :
Patients with Mechanical Heart Valves (MHVs) on oral anticoagulation (OAC) have an increased risk of bleeding and thromboembolic complications. The purpose of this study is to analyze the clinical and evolutive characteristics of patients underwent mechanical valve replacement (MVR) with thromboembolic (TE) or hemorrhagic events in OAC.
Patients and methods :
We made a retrospective study between November 2020 to December 2022 on 6 patients with TE and hemorrhagic complications, operated on for MVR at the Shisong Cardiac Center. Clinical patterns, paraclinical data and surgical outcomes were reviewed and descriptive statistical analysis done.
Results :
A total of 39 patients underwent valve replacement with MHVs during the study period. Of these, 6 patients had a thromboembolic and/or hemorrhagic complication, representing a frequency of 15.4%. The median age at surgery was 29 years (IQR 17-31). The OAC was acenocoumarolo and the median daily dose was 4 mg (IQR 3.3-4.0). The median of international normalized ratio (INR) at discharge was 3.5 (IQR 3.00-4.15). The median time between discharge and the TE or hemorrhagic event occurred was 2.5 months (IQR 1.25-3.75). Neurological deficit and altered consciousness were the reasons for admission to the emergency room for 100% of the cases. Major hemorrhagic and TE complications occurred in 5 patients (83.3%) and 1 patient (16.7%), respectively. On admission, the INR values collected were above the target ranges for 5 (83.3%) patients and these died from intracranial hemorrhage during hospitalization.
Conclusions :
This study shows the poorly anticoagulation control in young patients with MHVs in a developing country. Improving the care of patients with mechanical valves, remains an essential concern in the follow up and necessary to reduce the burden of complications in this population.
References
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