Multiple-shower thromboembolism in an artificial mitral valve patient

A 47-year-old male known to have an artificial valve was hospitalized in another hospital due to an acute illness. Anti-coagulation therapy was not provided during that hospitalization. He was transferred to our hospital due to lower limb weakness and diagnosed by us as having extensive emboli disease with complete occlusion of the distal aorta. Multiple infarcts were found in the abdominal organs and leg muscles. He suffered from multiple organ failure and eventually died.Neglecting the common practice of anticoagulation to a patient with a mechanical heart valve may, in rare cases, lead to immediate catastrophic event caused by shower thrombemboli with disseminated vascular occlusion from the left atrium to the abdominal aorta causing complete occlusion, spleen, kidney and muscle infarcts.Patients with mechanical valves require anticoagulation therapy, usually delivered by oral administration of warfarin, a vitamin K antagonist. Failure to administer adequate therapy monitored by serial measurement of INR carries the risk of thrombus formation on the artificial valve whose dislodgment can cause catastrophic outcomes [1-3]. Routine INR measurement and adequate anticoagulation can be performed in hospitals, community clinics and even at home. Patients with mechanical heart valves are usually aware of the dangers of inadequate therapy. Those who are hospitalized are usually well monitored by daily blood tests and INR measurements, especially when they are known to be taking warfarin. There are many reasons for discontinuing warfarin therapy, including the inability to take oral medications due to an acute medical condition or a disturbance in the normal coagulation cascade (e.g., disseminated intravascular coagulation). Patients who can not take their regular warfarin therapy are put on unfractionated or low molecular weight heparin therapy. Warfarin should not, however, be stopped in a patient with a mechanical valve, and if there is no other option, replacement the