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- W4380291684 abstract "Protein S deficiency is a form of thrombophilia in which the anticoagulant protein S is underproduced or not produced at all by the body. Lifelong anticoagulation is the mainstay of treatment. Transcatheter aortic valve replacement (TAVR) is a current treatment modality for patients with severe aortic stenosis. We are reporting the case of a patient with this disease who underwent a TAVR procedure and experienced valve leaflet thrombosis and large arterial thrombosis in the following months while fully anticoagulated with typical anticoagulation methods including warfarin, apixaban, and enoxaparin. Literature-based guidance is lacking with regard to anticoagulation in the setting of TAVR patients, especially in those with protein S deficiency. Based on our observations, warfarin was the better long-term prophylactic management method for our patient's protein S deficiency. Enoxaparin was most useful during periods of elevated thrombosis risk, including intra-/post-operative care and prolonged hospitalization periods. In the setting of her TAVR, we observed that warfarin use with a target international normalized ratio (INR) of 2.5-3.5 was the most effective outpatient treatment for the reversal of thrombosed bioprosthetic valve and improvement of cardiac ejection fraction. It is also possible that initial post-operative warfarin use would have been the most effective means of preventing valve thrombosis entirely in our protein S-deficient patient." @default.
- W4380291684 created "2023-06-13" @default.
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- W4380291684 date "2023-05-09" @default.
- W4380291684 modified "2023-10-01" @default.
- W4380291684 title "Hypercoagulable State and Thrombosis of Bioprosthetic Transcatheter Aortic Valve Replacement (TAVR) Refractory to Common Anticoagulation Methods in the Setting of Protein S Deficiency" @default.
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- W4380291684 doi "https://doi.org/10.7759/cureus.38754" @default.
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