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2018, vol. 37, br. 1, str. 18-20
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Oralna antikoagulantna terapija posle izolovane zamene aortne valvule
Oral anticoagulation after isolated aortic valve replacement
Sažetak
Aorte stenoza je najčešća bolest valvula koja zahteva zamenu bilo operativnim lečenjem bilo transkateter intervencijom i to kako u Evropi tako i u Severnoj Americi, sa rastućom rasprostranjenošću zbog starenja stanovništva. Prikazali smo bolesnicu koja je upućena u naše kardiološko odelenje na tronedeljni program kardiološke rehabilitacije nakon izolovane zamene aortne valvule mehaničkom protezom. Kardiološka rehabilitacija ima za cilj da poboljša funkcionalni kapacitet aerobnim fizičkim treningom i optimizira terapiju sa posebnim osvrtom na upotrebu oralnih antikoagulanasa. Bolesnica je uspešno završila program, unapredila funkcionalni kapacitet i dostigla ciljne vrednosti INRa. Izbor oralne antikoagulantne terapije nakon zamene zalistaka mehaničkim protezama prema preporukama i evropskog i američkog udruženja kardiologa je VKA, sa ciljnim INRom koji je definisan u odnosu na trombogenost mehaničkih proteza i prisustvo faktora rizika (mitralni ili trikuspidni veštački zalistak, prethodne tromboembolijske komplikacije, atrijalna fibrilacija, EF 35%, mitralna stenoza).
Abstract
Aortic stenosis is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America, with a growing prevalence due to the ageing population. In this case report we present case of a patient who was referred to our cardiology department for in-patient exercise based cardiac rehabilitation after isolated aortic valve replacement and who was treated successfully with special emphases on anticoagulant therapy choice and patient education. Novel oral anticoagulant was replaced with VKA according to guidelines. Regarding oral anticoagulants, guidelines from both sides of the Atlantic ocean remain the same. Oral anticoagulation using a VKA is recommended lifelong for all patients with mechanical prosthesis! INR self-management is recommended. Target INR after mechanical prosthesis according the 2017 Guidelines will depend on prosthesis trombogenicity and patient related risk factors (mitral or tricuspid valve replacement, previous thromboembolism, atrial fibrillation, mitral stenosis any degree, LVEF <35 %).
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