Rapidly Progressive and Catastrophic Calciphylaxis After Mechanical Valve Replacement: An Anticoagulation Dilemma

Philippe F Nyembo; Keith E Eidman; Mengistu Simegn; Andrew W Shaffer; Gautam R Shroff

doi:10.1016/j.jaccas.2022.07.034

Rapidly Progressive and Catastrophic Calciphylaxis After Mechanical Valve Replacement: An Anticoagulation Dilemma

JACC Case Rep. 2022 Oct 5;4(19):1319-1323. doi: 10.1016/j.jaccas.2022.07.034.

Authors

Philippe F Nyembo¹, Keith E Eidman¹, Mengistu Simegn¹, Andrew W Shaffer², Gautam R Shroff¹

Affiliations

¹ Hennepin County Medical Center, Minneapolis, Minnesota, USA.
² Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Abstract

Warfarin is the only approved anticoagulant after mechanical valve replacement, but it is a well described risk factor for calciphylaxis among patients with end-stage kidney disease. Our patient with end-stage kidney disease rapidly developed calciphylaxis after dual mechanical valve replacement in association with warfarin initiation, posing significant challenges in clinical management and a fatal outcome. (Level of Difficulty: Intermediate.).

Keywords: DOAC, direct oral anticoagulant; ESKD, end-stage kidney disease; anticoagulation; disorders of calcium disease; thrombosis; valve replacement.

Publication types

Case Reports