Do Patients With High CHA₂DS₂-VASc Scores Need High Intensity of Anticoagulants After Valve Surgery?

Abstract

Background: Asian patients on warfarin therapy usually have lower international normalized ratio (INR) intensities than those recommended by Western clinical practice guidelines. This study evaluated whether a high INR reduces the incidence of thromboembolism (TE) or bleeding events in Asian patients with high CHA2DS2-VASc scores after valve surgery. Methods and Results:Data of adult patients after valve surgery were retrieved from an integrated healthcare information system of a single hospital between 2014 and 2016. The INR was derived from the closest laboratory data before the index outpatient-clinic visit date. The endpoint of every record was determined as emergency room visit or hospitalization because of TE or bleeding event. A total of 37 TE or bleeding events were retrieved from 8,207 records; the annual incidence rate were 1.2% and 2.8% for low (0-2) and high (3-8) CHA2DS2-VASc score groups, respectively (P=0.007). The incidence rates were lowest for both groups at an INR of 1.5-2.0. High INR intensities did not reduce TE or bleeding incidence. INR >3.0 was associated with increased TE or bleeding incidence in the high-score group (6.8%/year vs. 2.0%/year, P=0.079). Conclusions:The optimal INR is 1.5-2.5 for low-or high-score Asian patients after valve surgery. INR >3.0 was associated with increased TE or bleeding incidence in the high-score group.

What Is The Success Rate of Patients Using Warfarin In Maintaining Their Target International Normalized Ratio Levels?

“…There are studies involving patients applying to EDs due to warfarin-related complications, and the ratio of patients within the therapeutic range is generally consistent with our findings. [14][15][16] Although an increase in INR level from 1 to 2 indicates a twofold hemorrhage risk, it has been reported that the incidence of intracranial hemorrhage is higher after values greater than 3.9. 4,17 The supratherapeutic INR rate in our study was 34.4% and the number of participants who reported major hemorrhage in the past was higher compared to the general literature (13.9%).…”

Genotype-Guided Warfarin Dosing in Patients With Mechanical Valves: A Randomized Controlled Trial

“…However, this target INR is not popularly accepted even in Japan [23]. Recently, two studies have suggested that a lower target INR (1.5 to 2.6) may be appropriate for East Asians with mechanical valves than that recommended by Western guidelines [23,24]. Figure 1 shows the enrollment, allocation, and follow-up of the trial.…”

Association between SLICC/ACR damage index and outcomes for lupus patients after cardiac valve surgery

“…The selection of prosthetic valve was made with a joint discussion between the surgeons and the patients according to the current valve surgery guideline, clinical condition, anticoagulant compliance and the patients’ subjective willing. The target international normalized ratio (INR) for patients with mechanical prostheses replacement was controlled between 2.0 and 2.5 for mitral position and between 1.5 and 2.5 for aortic position, controlled directly by the surgeon and the rheumatologist [ 5 ]. For patients receiving xenograft prostheses, Vitamin-K antagonist was prescribed for 3 months after the operation.…”