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A Journal on Internal Medicine

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Panminerva Medica 2002 December;44(4):359-63

language: English

Protein C, S and antithrombin III levels in patients with acute mechanical valve thrombosis

Tütün U. 1, Ulus A. T. 1, Aksöyek A. 1, Kaplan S. 1, Ayaz S. 2, Yilmaz S. 2, Birincioglu L. 1, Katircioglu S. F. 1

1 Department of Cardiovascular Surgery, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
2 Department of Hematology Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey


Background. Mechanical pros­thetic ­heart ­valve throm­bosis is a ­serious com­pli­ca­tion ­with an inci­dence of 1-6%. The reduc­tion in ­active ­vitamin-K depen­dent pro­tein C and S ­levels ­caused by war­farin treat­ment ­also ­results in a pro­throm­botic ­state. This ­study was con­ducted to inves­ti­gate the con­nec­tion ­between pro­tein C (PC), pro­tein S (PS), anti­thrombin III (ATIII) defi­ciency and pros­thetic mechan­ical ­valve throm­bosis.
Methods. Twenty-­nine of the 283 ­patients who under­went ­valve replace­ment ­with St. Jude med­ical pros­thesis had mechan­ical ­valve throm­bosis (­group 2). The ­rest ­were con­sid­ered as ­group 1. Twelve of the 29 ­patients (41.4%) had iso­lated ­aortic ­valve replace­ment, 12 had iso­lated ­mitral ­valve replace­ment (41.4%) and 5 ­patients had ­double ­valve replace­ment (17.2%). Most of the ­patients had rheu­matic ­valve dis­ease at ­their1st oper­a­tion. The ­mean ­time of occur­rence for mechan­ical ­valve occlu­sion was 4.1±1.0 ­years fol­lowing sur­gery.
Results. The ­values of PC, PS and ­ATIII ­were ­obtained ­when the mechan­ical ­valves ­stuck or at rou­tine ­follow-up. PC, PS and ­ATIII ­levels ­were sig­nif­i­cantly ­lower in the mechan­ical ­valve throm­bosis ­group. PC ­levels ­were 75.4±37.6% and 49.9±32.2% in ­group 1 and 2, respec­tively (p=0.001). PC, PS and ­ATIII ­values ­were ­mostly ­lower in the 2nd ­group but ­this dif­fer­ence ­only ­became sig­nif­i­cant ­after at ­least 2 ­years of war­farin ­usage.
Conclusions. Natural anti­co­ag­u­lant ­levels can be low ­during the use of war­farin. In ­which ­case the ­dose can be ­increased in ­order to ­hold the inter­na­tional nor­mal­ized ­ratio (INR) at 3-3.5. However, ­more fre­quent ­follow-up is ­required and ­patients ­should be inves­ti­gated for hyper­coag­u­la­tion ­states or defi­ciency in anti­co­ag­u­lant pro­teins. Patients ­referred to hos­pital ­with any mechan­ical ­valve throm­bosis or recur­rent throm­boem­bo­lism ­should be eval­u­ated for hyper­coa­gu­lant pro­teins.

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