Anticoagulation

Oral anticoagulants (Acitrom) is prescribed to prevent blood clot formation on and around the mechanical valve. This drug must be taken carefully and under supervision. If the level of drug is not enough. Blood clot may form on the valve and can clog the valve or can produce a stroke. Excess level of this drug can cause bleeding, both externally and internally.

Your doctor will determine the level of anticoagulant that is right for you. To maintain proper levels of anticoagulation, take your medication as prescribed and follow up with blood tests as scheduled. The dosage will be closely monitored by blood tests. The blood tests include a PT or INR.

Some important points of anticoagulant therapy are:

1. Take drug carefully. See the strength of the tablet. Acetrom is available in 1mg, 2mg, 3 mg and 4 mg strength. Preferably take the drug at a fixed time of the day:
2. Regular follow-up visit to your doctor.Get your Prothrombin (PT) done at each visit. The INR (International Normalized Ratio) should be between 2 and 4.
3. Avoid food rich in Vit-K
4. Avoid alcohol
5. If you develop some other ailment, inform the treating doctor that you are receiving oral anticoagulants. Some drugs (amiodarone, propranolol, sulfinpyrazone, cotrimazole, ciprofloxacin, erythromycin, isoniazide, metronidazole, fluconazole, aspirin, ibuprofen, cimetidine, omeprazole, tamoxifen, danazole etc.) increase the effect of Acitrom while other (rifampicin, carbamazepine, phenobarbital, phenytoin, sucralfate etc) decrease its effect. Thus dosage adjustment may be required.
6. Inform the doctor if you develop any of the following:
   • Excessive menstrual bleeding
   • Blood mixed urine
   • Bloody or black, tarry stools
   • Unusual nosebleeds
   • Bleeding gums
   • New onset, resistant headache

PREGNANCY

In cases of young female patients, if pregnancy is anticipated in future, it should be discussed with the cardiac surgeon, even before surgery. If pregnancy is anticipated, valve repair, bioprosthesis, homografts or autografts are preferred options because use of oral anticoagulants during pregnancy may cause neurological or skeletal/facial abnormalities in the fetus. Also it may increase the chances of fetal loss and bleeding at the time of child birth.

RECOMMENDATIONS FOR FEMALE PATIENTS RECEIVING ORAL ANTICOAGULANTS

1. No unplanned, unsupervised pregnancy. Inform the doctor if you have become pregnant or are planning to become pregnant.
2. Plan hospital delivery only.
3. Regular check-up during pregnancy
4. Hospitalization 2 weeks before the date of delivery. In hospital, oral anticoagulants are stopped and Heparin is started which is continued for one week after delivery.
5. Inform your doctor urgently, if you develop any of the following:

   Anticoagulation related bleeding

   ·
   1. Valve Thrombosis: The valve clicks usually decrease in intensity or disappear. Patient develops new onset shortness of breath and effort- intolerance.
   2. Thromboembolism:Blood clot from the valve may go to the brain or any of the limbs. If clotreaches to brain, the patient may develop stroke.If it reaches to one of the limbs, there is sharp pain in the limb and the limb becomes cold.
   3. Prosthetic valve Endocarditis:Infection of the heart valve manifests as prolong, resistant fever,anaemia and sometimes smoky urine.