THROMBOEMBOLISM IN PROSTHETIC VALVE ENDOCARDITIS AND ANTICOAGULANT THERAPY

The clinical results of thromboembolism (TE) in Patients with prosthetic valVe endocarditis (PVE) and anticoagulant therapy were studied. 22 PVE patients (ll males and females each from 4 to 59 years old, average 32.7) were selected from 1939 patients who had undergone valve replacement at this hospital from 1964 and 1985. The complication frequency of TE and its clinical results, anticoagulant therapy and coagulation tests were investigated. Diagnostic criterion was determined in either of the following two: l) those patients who experienced valve replacement, with at least gradual pyrogenic symptons and inflammation factors such as a large increase in white blood cells, the progress of ESR and positive CRP, also with the same bacterium found more than twice in blood culture, also with the same bacterium found more than twice in blood culture, or 2) those patients who experienced valve replacement, with bacterial verruca found at re-valve replacement or at pathological anatomy. PVE onset took 2 days to 6.5 years (average 407 days) to appear after valve replacement. 8 out of the 22 PVE patients (36.3%) showed complications at TE onset, and 5 out of the 8 patients repeated. Embolism was found in 6 cases of brain, 4 cases of kidney, 2 cases of lung, 2 cases of limbs and 1 case of spleen, and 8 patients all died. On the other hand, 5 complications (22.7%) at bleeding were found in 3 cases of brain, 1 case of duodenum and 1 case of site of replaced aortic valve, and 4 patients died. Anticoagulant therapy was given to 21 out of the 22 PVE patients, and thrombotest (TT) values at TE onset were all less than 30%. Warfarin was administered as anticoagulant. 2 patients were administered with aspirin, but one was given with 250mg aspirin per day together with warfarin, and the other with 330mg aspirin per day alone. TT values at the onset of bleeding were from 10 to 56%. Anticoagulant therapy had been performed to the PVE patients since PVE onset did not yet appear, but complications coagulability by TT values, and all the patients died. In addition to this, complications at bleeding were found many and most of patients died even when the TT values were not so low. Therefore, we believe that the anticoagulant therapy that had been performed after PVE onset still needs further studies.