Hepatobiliary malignancy presenting as deranged coagulogram in postoperative mechanical valve replacement patients

Valve replacement still defines a major proportion of valvular cases in cardiothoracic surgery in a developing country like India. With most patients getting a mechanical prosthetic heart valve and dependent on lifelong anticoagulation, regular international normalized ratio (INR) monitoring is warranted to maintain the optimum range while evaluating for any adverse effects in follow-up. We describe two postoperative patients of mechanical valve replacement on anticoagulant and antiplatelet, presenting with complaints of jaundice, bleeding, and deranged INR diagnosed with hepatobiliary–pancreatic malignancies. Although deranged coagulogram is mostly resulting from dosage modification of anticoagulants and dietary modifications, it should be sought out carefully, particularly in patients with a previously stabilized profile on a similar dosage and not be dismissed on account of anticoagulant therapy, especially if the patient is icteric.