Key result
AF linked to ~16-fold higher thromboembolic risk in mechanical mitral valves, while compliance reduces bleeding.
Why the study?
A mathematical model to predict thromboembolic and bleeding complications after mitral valve replacement with mechanical prostheses based on multiple risk factors was needed.
What are the predictors of thromboembolic and bleeding complications in patients after mitral valve replacement with mechanical prostheses?
Observational (n=260)
What are the predictors of thromboembolic and bleeding complications in patients after mitral valve replacement with mechanical prostheses?
Atrial fibrillation, specific prosthesis types, and elevated soluble fibrin-monomeric complexes significantly increase the risk of thromboembolic complications after mechanical mitral valve replacement, while poor compliance increases bleeding risk.
Answers are grounded in this paper and cite their sources.
AF and compliance warrant close monitoring after mechanical mitral replacement; observational data leave open whether interventions improve outcomes.
The aim of the study. To develop a mathematical model for predicting the development of thromboembolic complications and bleeding in patients after mitral valve replacement with mechanical prostheses based on an analysis of a number of risk factors – age, compliance, heart rate at the postoperative stage, prosthesis manufacturer, hemostasis indicators. Materials and methods. There were examined 260 patients. The following risk factors were analyzed: patient compliance (Morisky-Green test), heart rate at the postoperative stage, prosthesis manufacturer (MedInzh, Carbomedics, ATS, On-X), hemostasis indices (international normalized ratio, activated partial thromboplastin time, D-dimer, fibrinogen, soluble fibrin-monomeric complexes). Results of the study and conclusion. The frequency of thromboembolic complications was 5.2 cases, bleeding 4.7 cases per 1000 patient-months. With an increase in the level of soluble fibrin-monomeric complexes by 1 g/L, the risk of thromboembolic complications increases by 1.63 times, the presence of a MedInzh’s prosthesis increases the risk of thromboembolic complications by 2.04 times compared to prostheses of other companies, with paroxysmal or permanent forms of atrial fibrillation the risk thromboembolic complications increase 16.29 times compared with patients with sinus rhythm. In compliant patients, the risk of bleeding is 52.5 (1/0.08) times lower than in non-compliant patients; with an increase in the activated partial thromboplastin time by 1 sec, the risk of bleeding increases by 1.07 times.
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Markova et al. (2022) conducted an observational in Mitral valve replacement with mechanical prostheses (n=260). Clinical and hemostatic risk factors (atrial fibrillation, MedInzh prosthesis, SFMC levels, non-compliance) vs. Reference groups (sinus rhythm, other prostheses, compliance) was evaluated on Thromboembolic complications and bleeding. In patients with mechanical mitral valves, atrial fibrillation increased thromboembolic risk 16.29-fold compared to sinus rhythm, while patient compliance reduced bleeding risk 52.5-fold.
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