Are Patients with Mechanical Valves Contraindicated for Rhinoplasty?

Dear Darren,

 

It is absolutely important to address the issue of your blood thinner and the INR not to mention your risk of valve infection.

Therefore, a close collaboration between your cardiologist and your plastic surgeon is crucial to minimize the risks of your rhinoplasty as much as possible.

So, if the aforementioned points were covered and your blood tests and examinations came out to be suitable for a surgery then things will be on the right track for a rhinoplasty.

I hope this helps.

Thank you for your inquiry.

The best of luck you.

Dr. Sajjadian

This is a very interesting question. I would not want to do the surgery with your INR prolonged. perhaps you should first check with your Cardiologist or Cardiac surgeon to see what other steps could be taken to adequately protect the valves and not increase your risk of post-op bleeding. Good luck.

Rhinoplasty is not contraindicated when a patient has a mechanical aortic valve in place.  Patients will need to be cleared by their cardiologist and placed on antibiotics to prevent seeding of any bacteria onto the prosthetic heart valve.  All aspirin and blood thinning products must be stopped so that patients are not anticoagulated prior to undergoing rhinoplasty surgery.  This may put the patient at risk from a blood clotting perspective and that risk will have to be weighed by the patient and their surgeon.

There are 2 issues in your case the first being the anticoagulation and the second the risk of infection to the heart valve. The first is addressed by temporarily switching to a low molecular weight heparin anticoagulation and the second by taking specific antibiotics around surgery. Your surgeon and cardiologist should work together on this.

An INR of 1.5 is usually considered therapeutic but I would not recommend elective surgery with that level of INR.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

This is a question that should be answered by your cardialogist or internist. You are on anticoagulants because of the risk or showing blood clots from your valve and rhinoplasty is a procedure that can get bloody at times. You would need to be off of the anticoagulants before and after surgery and your doctors would need to advise you on the risks.

I would consider the procedure but only after consulting with the patient's cardiologist and those managing the INR. I'm less concerned about possible infection but certainly would prescribe antibiotics.