CHEST Guidelines-Antithrombotic-and-Thrombolytic-Therapy-for-Valvul

Antithrombotic-and-Thrombolytic-Therapy-for-Valvul

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The document summarizes the guidelines provided by the American College of Chest Physicians (ACCP) on antithrombotic therapy for valvular disease. It addresses various situations where antithrombotic therapy is applied and details different approaches based on specific conditions or types of valvular disease, while weighing the risks of thromboembolism against hemorrhagic risks associated with the therapy.<br /><br />Key recommendations include:<br />1. For patients with rheumatic mitral valve disease and a left atrial diameter greater than 55 mm, vitamin K antagonist (VKA) therapy is suggested to prevent thromboembolism. If there is a left atrial thrombus, VKA therapy is strongly recommended.<br />2. In cases of percutaneous mitral valvotomy for patients with left atrial thrombus, VKA therapy should be continued until thrombus resolution; if thrombus persists, the procedure should not be performed.<br />3. For patients with cryptogenic stroke and patent foramen ovale (PFO), initial aspirin therapy is recommended. VKA therapy should be considered if there are recurrent events.<br />4. The use of anticoagulants or antiplatelet agents for native valve endocarditis is generally not recommended unless there is a specific separate indication.<br />5. Following bioprosthetic valve implantation, aspirin is recommended for aortic valves initially, with considerations for adding clopidogrel for transcatheter aortic valves.<br />6. Long-term VKA therapy is recommended for mechanical valves with a target INR of 2.5 for aortic, and 3.0 for mitral or double valve configurations.<br />7. The addition of low-dose aspirin (50-100 mg/day) is suggested for mechanical valve patients at low bleeding risk.<br />8. For prosthetic valve thrombosis, thrombolysis is recommended for right-sided valves, whereas surgery is suggested for larger left-sided thrombi, depending on thrombus size.<br /><br />The document underlines the importance of balancing the benefits of preventing thrombotic events against the potential for bleeding complications in each specific patient context and suggests tailoring therapy accordingly.

Keywords

ACCP guidelines

antithrombotic therapy

valvular disease

thromboembolism

vitamin K antagonist

rheumatic mitral valve

patent foramen ovale

bioprosthetic valve

mechanical valves

prosthetic valve thrombosis