Open AccessManagement dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding
Author(s) -
Prashanth Panduranga,
Mohammed Al-Mukhaini,
Muhanna Al-Muslahi,
Mohammed A. Haque,
Abdullah Shehab
Publication year - 2012
Publication title -
world journal of cardiology
Language(s) - English
Resource type - Journals
ISSN - 1949-8462
DOI - 10.4330/wjc.v4.i3.54
Subject(s) - warfarin , medicine , bleed , mechanical heart valve , fresh frozen plasma , prothrombin complex concentrate , mechanical heart , recombinant factor viia , intracranial bleeding , surgery , heart valve , anticoagulant , cardiology , atrial fibrillation , platelet
Management of warfarin-induced major bleeding in patients with mechanical heart valves is challenging. There is vast controversy and confusion in the type of treatment required to reverse anticoagulation and stop bleeding as well as the ideal time to restart warfarin therapy safely without recurrence of bleeding and/or thromboembolism. Presently, the treatments available to reverse warfarin-induced bleeding are vitamin K, fresh frozen plasma, prothrombin complex concentrates and recombinant activated factor VIIa. Currently, vitamin K and fresh frozen plasma are the recommended treatments in patients with mechanical heart valves and warfarin-induced major bleeding. The safe use of prothrombin complex concentrates and recombinant activated factor VIIa in patients with mechanical heart valves is controversial and needs well-designed clinical studies. With regard to restarting anticoagulation in patients with warfarin-induced major bleeding and mechanical heart valves, the safe period varies from 7-14 d after the onset of bleeding for patients with intracranial bleed and 48-72 h for patients with extra-cranial bleed. In this review article, we present relevant literature about these controversies and suggest recommendations for management of patients with warfarin-induced bleeding and a mechanical heart valve. Furthermore, there is an urgent need for separate specific guidelines from major associations/ professional societies with regard to mechanical heart valves and warfarin-induced bleeding.