Key result
A patient with On-X mitral and aortic valves who received little or no systemic anticoagulation for 5 months due to severe bleeding complications showed no evidence of valve thrombosis or thromboembolism.
Case Report (n=1)
No
This case suggests that On-X mechanical valves may be safe even with minimal or no systemic anticoagulation in patients with high bleeding risk.
Should not yet change anticoagulation practice for mechanical valves; hypothesis-generating case report requiring prospective validation.
Thromboembolism continues to be a major concern in patients with mechanical heart valves, especially in those with unsatisfactory anticoagulation levels. The new On-X valve (On-X Life Technologies, Austin, TX, USA) has been reported as having unique structural characteristics that offer lower thrombogenicity to the valve. We report a case where the patient received no or minimal systemic anticoagulation after placement of On-X mitral and aortic valves due to development of severe mucosal arterio-venous malformations yet did not show any evidence of thromboembolism. This case report reinforces the findings of recent studies that lower anticoagulation levels may be acceptable in patients with On-X valves and suggests this valve may be particularly useful in those in whom therapeutic levels of anticoagulation cannot be achieved due to increased risk of bleeding.
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Agarwal et al. (2015) conducted a case report in Mechanical heart valve replacement with high bleeding risk (n=1). Minimal or no systemic anticoagulation was evaluated on Thromboembolism or valve thrombosis. A patient with On-X mitral and aortic valves who received little or no systemic anticoagulation for 5 months due to severe bleeding complications showed no evidence of valve thrombosis or thromboembolism.
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