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===Excessive Anticoagulation and Serious Bleeding With Prosthetic Valves (DO NOT EDIT)===
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of fresh frozen plasma or prothrombin complex concentrate is reasonable in patients with mechanical valves and uncontrollable bleeding who require reversal of anticoagulation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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===Prosthetic Valve Thrombosis===
====Diagnosis and Follow-up====
{|class="wikitable" style="width:80%"
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Continuation of VKA anticoagulation with a therapeutic INR is recommended in patients with mechanical heart valves undergoing minor procedures (such as dental extractions or cataract removal) where bleeding is easily controlled.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' TTE is indicated in patients with suspected prosthetic valve thrombosis to assess hemodynamic severity and follow resolution of valve dysfunction.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Temporary interruption of VKA anticoagulation, without bridging agents while the INR is subtherapeutic, is recommended in patients with a bileaflet mechanical AVR and no other risk factors for thrombosis who are undergoing invasive or surgical procedures''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' TEE is indicated in patients with suspected prosthetic valve thrombosis to assess thrombus size and valve motion''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Fluoroscopy or CT is reasonable in patients with suspected valve thrombosis to assess valve motion. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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====Medical Therapy====
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Fibrinolytic therapy is reasonable for patients with a throm- bosed left-sided prosthetic heart valve, recent onset (<14 days) of NYHA class I to II symptoms, and a small thrombus (<0.8 cm2) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Fibrinolytic therapy is reasonable for thrombosed right-sided prosthetic heart valves ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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====Intervention====
{|class="wikitable" style="width:80%"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''Bridging anticoagulation with either intravenous unfractio- nated heparin (UFH) or subcutaneous low-molecular-weight heparin (LMWH) is recommended during the time interval when the INR is subtherapeutic preoperatively in patients who are undergoing invasive or surgical procedures with a 1) mechanical AVR and any thromboembolic risk factor, 2) older- generation mechanical AVR, or 3) mechanical MVR. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Emergency surgery is recommended for patients with a throm- bosed left-sided prosthetic heart valve with NYHA class III to IV symptoms''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of fresh frozen plasma or prothrombin complex concentrate is reasonable in patients with mechanical valves receiving VKA therapy who require emergency noncardiac sur- gery or invasive procedures ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Emergencysurgeryisreasonableforpatientswithathrombosed left-sided prosthetic heart valve with a mobile or large thrombus (>0.8 cm2) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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Revision as of 16:38, 27 October 2016


Excessive Anticoagulation and Serious Bleeding With Prosthetic Valves (DO NOT EDIT)

Class IIa
"1. Administration of fresh frozen plasma or prothrombin complex concentrate is reasonable in patients with mechanical valves and uncontrollable bleeding who require reversal of anticoagulation (Level of Evidence: B)"

Prosthetic Valve Thrombosis

Diagnosis and Follow-up

Class I
"1. TTE is indicated in patients with suspected prosthetic valve thrombosis to assess hemodynamic severity and follow resolution of valve dysfunction.(Level of Evidence: B)"
"2. TEE is indicated in patients with suspected prosthetic valve thrombosis to assess thrombus size and valve motion(Level of Evidence: B)"
Class IIa
"1. Fluoroscopy or CT is reasonable in patients with suspected valve thrombosis to assess valve motion. (Level of Evidence: C)"

Medical Therapy

Class IIa
"1. Fibrinolytic therapy is reasonable for patients with a throm- bosed left-sided prosthetic heart valve, recent onset (<14 days) of NYHA class I to II symptoms, and a small thrombus (<0.8 cm2) (Level of Evidence: B)"
"2. Fibrinolytic therapy is reasonable for thrombosed right-sided prosthetic heart valves (Level of Evidence: B)"

Intervention

Class I
"1. Emergency surgery is recommended for patients with a throm- bosed left-sided prosthetic heart valve with NYHA class III to IV symptoms(Level of Evidence: B)"
Class IIa
"1. Emergencysurgeryisreasonableforpatientswithathrombosed left-sided prosthetic heart valve with a mobile or large thrombus (>0.8 cm2) (Level of Evidence: C)"
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