Ah, but what needs to be clarified, is that these figures probably represent
embolism risk in a population of patients who are compliant with
anticoagulation. What we need to know are the embolism risks of patients who
are not anticoagulated. With many modern AVRs the embolism risks are not
very high, although this patient's INR of 3.5 suggests that he did indeed
require anticoagulation!
I'm still very worried about his temporal lobe...
AF
----- Original Message -----
From: "Andrew Webster" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, October 12, 2002 9:44 PM
Subject: Re: Anticagulation and Head injuries
> 29. Cannegieter SC, Rosendaal FR, Wintzed AR, Van D Meer FJM,
> Vandenbroucke JP, Breit E. Optimal oral anticoagulant therapy in
> patients with mechanical heart valves. N Engl J Med 1995;333:11-7.
>
> Mechanical Prosthetic Valves
> For mechanical prosthetic valves, the risk of thromboembolism varies
> with type and position. The lowest incidence occurring in patients with
> bileaflet valves (0.5%/per patient/per year) and the aortic position
> (0.5%/per patient/per year). Caged ball or disk valves have a risk of
> 2.5%/per patient/per year of thromboembolism. The current recommended
> INR for anticoagulation according to the ACCP Consensus is 2.5 to 3.5.
> However, Cannegieter, et al., suggested a target of 3.0 to 4.0, which
> may be optimal anticoagulation for caged ball valves.29
>
> Found this on a website, I suppose aortic region is a high flow valve
> decreasing risk of embolism.
>
> Andy Webster
> >
> > -----Original Message-----
> > From: Accident and Emergency Academic List
> > [mailto:[log in to unmask]] On Behalf Of John Ryan
> > Sent: 12 October 2002 12:16
> > To: [log in to unmask]
> > Subject: Anticagulation and Head injuries
> >
> > I am aware the list has discussed this topic recently but I would like
> > to
> > add a new slant.
> >
> > Views on how to manage a young man with a head injury and headache
> > following
> > a fall from his bicycle.... CT shows temporal contusion. This chap
> is
> > on
> > warfairn follwing his aortic valve replacement on a background of
> > Marfan's
> > Syndrome.
> >
> > The question is to reverse anticoagulation (INR 3.5) or not ?
> >
> > Dr John Ryan
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