First of all You have to be aware, that a non obstructive thrombosis of a mechanical valve may quickly become obstructive by only little further thrombus apposition in the area of the hinges !
The mean duration of iv heparin can hardly be predicted but, as to my experience, depends on the reduction of the thrombus mass, which should be controled daily by echo. Furthermore, warfarin should be started as early as possible, if no surgical intervention may be expected.
Thanx, Rainer Moosdorf · But Na heparin is only for sure therapeutic anticoagulation range, while VKA will in INR? Does Aspirin used after known thrombus at sub therapeutic INR with VKA?
You are absolutely right when starting with iv heparin in a therapeutic dosage, consequently controled by aPTT. My experience is also, that a very strict warfarin therapy with an INR of 3+ is very effective in NOPVT. As I said, You have to be quite sure not to go towards surgery, before You start and You should give warfarin overlapping with heparin, until You really reach a stable INR.
Should use Aspirin for long life, or is there any conception about it?
I do at least not know any concepts or any studies about Aspirin in this setting and I would not recommend it except in cases of concommitant coronary artery disease.
If it is diagnosed of NOPVT the iv heparin should be started immediately and mounter-ed by APTT at the same time the oral anti-coagulant medications should started like warfarin and the target of the INR when it is reached, the iv heparin will be stopped, which the heparin therapy might takes 3-4 days.
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