key: cord-0784546-0d9drre3
authors: Paone, Gaetano
title: Commentary: Cause for concern or one in 33 million?
date: 2020-10-22
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.10.033
sha: b79bdb0f7b7fe86f60257bd955d6cdf4d5c6ef3e
doc_id: 784546
cord_uid: 0d9drre3

nan

Acute thrombus formation on a bioprosthetic aortic valve in a COVID positive patient raises questions of frequency and the issue of routine warfarin anticoagulation after AVR.

Gaetano Paone MD, MHSA COVID cases worldwide exceed 33 million, with over 1 million deaths. In the US alone, over 7 million cases and more than 200,000 deaths have been reported. 1 Primary lung involvement predominates and disease severity ranges widely from asymptomatic subclinical infection to severe and potentially fatal respiratory distress syndrome. An associated coagulopathy seemingly mimics disseminated intravascular coagulopathy, with related thrombotic events, most commonly venous thromboembolism including pulmonary embolus. 2,3 Cardiac manifestations, including arrhythmias, acute myocardial injury and myocarditis have been increasingly recognized and reported. [4] [5] [6] In this issue of JTCVS Techniques, Manghat 7 COVID aside, despite evidence for subclinical leaflet thrombosis after both transcatheter aortic valve replacement (TAVR) and SAVR, and an AHA/ACC Guideline recommendation for routine anticoagulation of bioprosthetic aortic valves for 3-6 months "…until the prosthetic valve is fully endothelialized," consensus regarding routine anticoagulation with Vitamin K antagonists remains lacking. [8] [9] [10] [11] [12] [13] [14] In this context, routine warfarin anticoagulation for all patients after tissue AVR on the basis of this single case seems, if not excessive, then at least premature.

Understanding whether or not this case as the authors suggest, "…serves as a timely reminder of the consequences of COVID-19…", will indeed require additional study going forward. It does, however, as they to their credit very transparently acknowledge, demonstrate the importance of "clinical and radiological vigilance." This includes not only considering the appropriate diagnostic tests, but importantly, having timely access to the requisite expertise needed to J o u r n a l P r e -p r o o f accurately interpret and report the findings from these increasingly sophisticated radiologic and echocardiographic examinations essential to our diagnostic capabilities.

WHO Coronavirus Disease

COVID-19 and its implications for thrombosis and anticoagulation

COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review

Cardiac manifestations in COVID 19 patients-A systematic review

Myocardial injury and COVID-19: Possible mechanisms

Cardiac involvement in COVID 19 patients: Risk factors, predictors, and complications: A review

Acute post-operative thrombosis of an aortic valve prosthesis and embolic myocardial infarction in a COVID-positive patient -an unrecognised complication

AHA/ACC Focused update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Possible subclinical leaflet thrombosis in bioprosthetic aortic valves

Prosthetic heart vale thrombosis; state of the art review

Should bioprosthetic aortic valves be routinely anticoagulated? Insights from the PARTNER and beyond

Early thrombosis risk in patients with biologic valves in the aortic position

Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy

Anticoagulation after surgical or transcatheter bioprosthetic aortic valve replacement