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Mechanical valve and TKR (Bridging therapy (Type of therapy dependent on…
Mechanical valve and TKR
Summary
Elderly patient having major orthopaedic surgery with background high risk thromboembolic disease on therapeutic anticoagulation
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High risk
Mechanical mitral valve - large valve area, low flow
Age, smoking, other comorbidities (?AF - freq associated with mitral disease)
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Discuss with: haematology, cardiology, surgery team
Bridging therapy
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Strategy employed should be guided by hospital protocols in consultation with haematology department
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Intraop
Day of surgery
Therapeutic LMWH 12 hours prior if BD, 24 hrs prior if daily
Check INR, should be <1.5 for operation or neuraxial
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