Abstract:
Background. Patients with mechanical heart valve prostheses require strict and continuous
oral anticoagulation to effectively prevent thromboembolic complications. Subtherapeutic
INR levels increase the risk of intracardiac thrombus formation and systemic embolism,
requiring urgent, multidisciplinary management.
Objective(s). Highlighting the consequences of ineffective anticoagulation in patients with
mechanical valve prostheses and describing the multidisciplinary management of an
ischemic stroke of cardioembolic origin.
Materials and methods. A 65-year-old woman with a mechanical mitral valve and atrial
fibrilation was admitted to the cardiology clinic for cardiac symptoms. ECG, coagulation
tests, and echocardiography were performed. She developed acute ischemic stroke with left
hemiparesis, confirmed by CT and angio-CT showing right MCA occlusion, successfully
treated by thrombectomy.
Results. The patient presented with dyspnea, palpitations, and chronic fatigue. ECG showed
atrial fibrillation with HR 75 bpm, left bundle branch block, and subtherapeutic INR (1.7).
Echocardiography revealed a 10 mm floating mass on the ventricular side of the mitral
prosthesis. She later developed ischemic stroke with left hemiparesis. Brain CT and angioCT confirmed a right M1 MCA thrombus. Successful endovascular thrombectomy was
performed in the neurology clinic. Repeat echocardiography showed no mass, confirming
the cardioembolic origin. Neurological deficit improved, anticoagulation was adjusted, and
INR was within target (2.52) at discharge.
Conclusion(s). Subtherapeutic INR in patients with mechanical valve prostheses increases
the risk of thromboembolic complications. A multidisciplinary approach and timely
intervention within the therapeutic window are essential for neurological recovery. INR
monitoring and patient education remain key priorities.
