When given a D-dimer elevation of 6893 μg/L, a chest computed tomography is done which excludes pulmonary embolism but shows dilation of the left atrium (LA) and signs of pulmonary hypertension. The patient is tested coronavirus disease 2019 positive, and the first symptoms appearĪdmission to the emergency department of secondary care hospital for respiratory distress and palpitations. The patient, implanted with a Medical Medtronic ATS 27 mm mechanical mitral valve for severe mitral stenosis and under acenocoumarol treatment, had received 10 mg of oral vitamin K following an international normalized ratio (INR) of 7.7 We report the discussion regarding the diagnostic and therapeutic management of a heart valve thrombus in the setting of SARS-CoV-2 infection and the need or not for change in anticoagulation therapy in this context. The following clinical case report describes a patient with a mechanical mitral valve on adequate acenocoumarol treatment with severe SARS-CoV-2 infection. 1 This observation raises the question of anticoagulation, in both, patients without prior anticoagulation and particularly previously anticoagulated patients, whose data and recommendations in this context are very limited. This complication can affect up to a third of intensive care patients. Since the beginning of the SARS-CoV-2 pandemic, which began at the end of 2019, numerous studies have reported a wide range of different clinical manifestations of this pathology, including a hypercoagulable state. Standardized prophylactic anticoagulation protocols for inpatient and outpatient settings are needed due to the high risk of thromboembolic events in COVID-19 patients. Therefore INR therapeutic ranges between 2.0-3.0 are recommendable both for the prevention of TE and bleeding complications.The incidence of thrombo-embolic events may increase during the coronavirus disease 2019 (COVID 19) pandemic, due to the procoagulant state induced by severe acute respiratory syndrome coronavirus 2 infection.Ĭarriers of mechanical heart valves are at risk of valve thrombosis in the clinical setting of COVID-19 infection. In conclusion, with INR greater than 2.75, no thromboembolic complication occurred, but several hemorrhagic complications occurred at INR greater than 3. As is seen in figure 4, mean INR values in TE patients were 1.28, in patients with bleeding complications 4.1, and in event free patients 2.07 respectively. 157 patients (mean age 55 +/- 12 y.o.) with various cardiovascular diseases (Table 2) were followed up for a mean of 4.9 +/- 3.2 years. The average TT and INR values in 5 patients with TE were 26.4% and 1.53 respectively and this was significantly (p < 0.01) higher (smaller) than in TE-free patients. The average TT and INR values in TE-free patients among 101 in whom coagulability could be measured, were 21.1% and 1.73 respectively. Regarding the 170 patients with prosthetic valves with a mean follow-up period of 2.44 years, 9 thromboembolisms (TE) were reported. The thrombotest, prothrombin time and INR were measured at follow-up visits every month. We investigated paying special interest to INR, the effectiveness of oral anticoagulant therapy in 170 prosthetic valve patients and in 157 patients with various cardiovascular diseases who received warfarin at two different centers. Prothrombin time, prothrombin time ratios (PTR) and thrombotest have been employed so far, but, recently, International Normalized Ratio of prothrombin time (PT-INR or INR) has been introduced. Optimal therapeutic ranges for an oral anticoagulant therapy has been discussed for many years.
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