DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives.

Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it is far from perfect. Direct oral anticoagulants (DOACs) are a new and more patient-friendly alternative to warfarin when anticoagulation is required, but have not yet been approved for the indication of mechanical valves. EVIDENCE ACQUISITION: A literature search of Pubmed, Embase, Web of Science (Core Collection), and Cochrane Library (from inception to May 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the Appendix. Only prospective clinical trials were included in this review. A total of 10 publications were included in this review. RELEVANCE TO CLINICAL PRACTICE: This systematic review summarizes the different types of DOACs and their possible use in the anticoagulation of mechanical valves. We aim to propose future directions in anticoagulation research for mechanical valves. CONCLUSIONS: DOAC use in MHVs has been halted due to the failure of both dabigatran and apixaban in two major clinical trials. However, rivaroxaban was successful in two small clinical trials. Ample research is still needed to explore new valve designs as well as new anticoagulation targets.

Precipitation of struvite using MgSO4 solution prepared from sidestream dolomite or fly ash.

Struvite (NH4MgPO4∗6H2O) is a slow-release fertilizer produced from phosphorus and nitrogen-containing wastewater in the presence of Mg salts. Commercial Mg salts are the single most significant cost of struvite precipitation. In this study, H2SO4 formed as an industrial sidestream was used to prepare MgSO4 solution from waste dolomite (DOL) and fly ash (FA). MgSO4 solution was then used to precipitate struvite from a synthetic (NH4)2HPO4 solution and from actual industrial process waters. The best results were obtained with real process waters where over 99% of phosphate and about 80% ammonium removals were achieved with both MgSO4 solutions after 30 min of reaction time. A higher molar ratio between Mg and P improved the phosphate removal efficiency, especially with DOL-based MgSO4 solutions; however, it had no practical effect on ammonium removal. The struvite content of precipitates was 75.49% with an FA-based chemical and 60.93% with a DOL-based chemical; other valuable nutrients (Ca, K, S, Fe, Mn, and Cl) were captured in the precipitates. The results indicate that both sidestream-based reagents perform well in struvite precipitation and that the formed precipitates could be used as fertilizers.