What is the recommended strategy for anticoagulation management in a patient with a mechanical mitral valve undergoing knee arthroplasty?

For a patient with a mechanical mitral valve undergoing knee arthroplasty, the recommended strategy for anticoagulation management involves bridging warfarin therapy with enoxaparin. This is vital due to the increased risk of thromboembolism associated with mechanical valves, particularly during surgical procedures.

Patients with mechanical heart valves are at a higher risk for developing thromboembolic events, especially when anticoagulation is interrupted. Therefore, for patients undergoing procedures such as knee arthroplasty, it’s essential to maintain anticoagulation to mitigate these risks. Continuing warfarin during the procedure is usually not recommended due to the potential for bleeding, as warfarin does not provide optimal hemostatic control during surgery.

Bridging with enoxaparin allows for temporary anticoagulation during the period when warfarin is held prior to the procedure and then reinitiated afterward. This strategy ensures that the patient retains adequate anticoagulation to prevent thromboembolic complications from the mechanical valve while managing the increased risk of bleeding from the surgical intervention.

Initiating therapy with a direct oral anticoagulant (DOAC) is not advisable in this scenario due to the lack of established protocols for patients with mechanical heart valves and the potential