Open AccessHyperthyroidism in severe mitral regurgitation post mechanical mitral valve replacement: the effect on warfarin anticoagulation
Author(s) -
Gracia Lilihata,
Charles Saputra,
Dian Yaniarti,
Rarsari Soerarso
Publication year - 2020
Publication title -
cardiovascular endocrinology and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.498
H-Index - 8
ISSN - 2574-0954
DOI - 10.1097/xce.0000000000000233
Subject(s) - medicine , warfarin , hypoalbuminemia , mitral regurgitation , mitral valve replacement , concomitant , cardiology , surgery , clotting factor , fresh frozen plasma , thyroid function , thyroid , mitral valve , atrial fibrillation , platelet
A 24-year-old male patient came to the emergency room with melena, gum bleeding and nosebleeds. This patient has a history of mechanical prosthetic mitral valve replacement for severe mitral regurgitation (MR) and consumed warfarin irregularly, but did not come back for regular check-up. Investigations showed greatly increased thyroid function and international normalised ratio (INR) was 15.8. Patients were diagnosed with thyroid storm and bleeding due to prolongation of INR. His hyperthyroid state might have caused increased rate of degradation of vitamin K-dependent clotting factor thereby increased sensitivity to warfarin. Concomitant acute decompensated heart failure, thrombocytopenia and hypoalbuminemia also contributed to his risk of bleeding. Treatment included anti-thyroid therapy as well as warfarin reversal therapy by stopping warfarin, low-dose intravenous vitamin K due to his mechanical prosthetic valve and fresh frozen plasma. In conclusion, hyperthyroidism could increase the response to warfarin so close monitoring is needed to balance the risk of bleeding and thromboembolism.