Is Chymoral Forte (Chymotrypsin) safe for patients with Aortic Valve Replacement (AVR)?

Safety of Chymoral Forte for AVR Patients

Chymoral Forte (chymotrypsin) is not recommended for patients with aortic valve replacement (AVR) due to potential bleeding risks that could compromise outcomes in these patients.

Understanding the Risk Factors in AVR Patients

• AVR patients require careful management of their coagulation status to prevent both thrombotic and bleeding complications 1
• Patients with mechanical aortic valves require lifelong anticoagulation therapy to prevent valve thrombosis and thromboembolic events 2
• Even patients with bioprosthetic valves may require anticoagulation or antiplatelet therapy, particularly in the first 3 months after surgery 3

Why Chymoral Forte Poses Risks for AVR Patients

• Chymoral Forte contains chymotrypsin, a proteolytic enzyme that can interfere with normal blood clotting mechanisms
• This interference could potentially:
  • Increase bleeding risk in patients already on anticoagulation therapy 2
  • Compromise the delicate balance between preventing thrombosis and avoiding hemorrhage that is crucial for AVR patients 2, 3

Clinical Considerations for AVR Patients

• AVR patients are already at risk for various complications including:
  • Thromboembolism and bleeding (3% risk in surgical AVR) 1
  • Valve thrombosis, particularly with mechanical valves 2
  • Paravalvular leakage 1
• Adding medications with potential anticoagulant properties like Chymoral Forte could further increase these risks 2

Management Recommendations

• Avoid medications that may interfere with coagulation in AVR patients unless specifically indicated 1, 2
• For AVR patients requiring anti-inflammatory therapy:
  • Consider alternatives with more predictable effects and established safety profiles in cardiac patients 1
  • Consult with the patient's cardiologist before initiating any medication that might affect coagulation 1

Special Considerations Based on Valve Type

• For mechanical valve recipients:
  • Maintain strict anticoagulation control within recommended INR ranges (typically 2.0-3.0) 2
  • Avoid any medication that might unpredictably alter coagulation status 2
• For bioprosthetic valve recipients:
  • Exercise caution particularly during the first 3 months post-implantation when thromboembolic risk is highest 3
  • Even after this period, carefully evaluate any medication that could affect bleeding risk 3

Clinical Monitoring if Use Cannot be Avoided

• If Chymoral Forte must be used for a specific indication in an AVR patient:
  • Monitor coagulation parameters more frequently 2
  • Watch for signs of bleeding or thrombotic complications 1, 2
  • Use the lowest effective dose for the shortest duration possible 1
  • Consider temporary adjustment of anticoagulation therapy under specialist supervision 2