Key result
Fluctuating INR levels between 2.1 and 6.0 in a patient on oral anticoagulants for prosthetic valves led to ischemic strokes and fatal intracranial hemorrhage.
Case Report (n=1)
This case highlights the critical need for judicious INR monitoring in patients on oral anticoagulants for prosthetic valves to prevent fatal hemorrhagic and ischemic complications.
INR fluctuations may cause severe events in prosthetic valve patients; leaves open optimal monitoring strategies pending prospective data.
Patients on long-term oral anticoagulant therapy (OAT) for prosthetic valves require close monitoring of their international normalized ratio (INR) levels to prevent deleterious effects. We present a case of a 35-year-old male with a known case of rheumatic heart disease who underwent mitral valve replacement and aortic valve replacement. In our patient, there was an undulation of coagulation parameters between low (INR-2.1) and high (INR-6.0) target levels, which eventually lead to ischemic strokes and fatal intracranial hemorrhage (ICH). Repeat INR was 6.0, which was much beyond the therapeutic range. Attempts to correct the coagulation abnormalities did not succeed and the patient succumbed to ICHs. All patients with valve replacement require chronic OAT. Judicious monitoring of the INR levels with dose adjustments can reduce morbidity and mortality from OAT-related complications like hemorrhage and infarction.
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Venati et al. (2015) conducted a case report in Rheumatic heart disease with prosthetic valves (n=1). Oral anticoagulant therapy (OAT) was evaluated. Fluctuating INR levels between 2.1 and 6.0 in a patient on oral anticoagulants for prosthetic valves led to ischemic strokes and fatal intracranial hemorrhage.
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