Efficacy and Safety of Very Low-Dose Self-Management of Oral Anticoagulation in Patients With Mechanical Heart Valve Replacement

Koertke, Heinrich; Zittermann, Armin; Wagner, Otto; Ennker, J.; Saggau, W; Sack, Falk–Udo; Cremer, Jochen; Huth, Christof; Braccio, Maurizio; Musumeci, Francesco; Köerfer, Reiner

doi:10.1016/j.athoracsur.2010.06.069

Cited by 42 publications

(31 citation statements)

References 17 publications

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“…The intensity standard in Germany is even lower (i.e., INR of 1.75-2.75) [13,14]. In a recent German study on anticoagulation, the INR target value was set at 2.0 (range of 1.6-2.1) for patients with aortic valve replacement, and 2.3 (range of 2.0-2.5) for patients with mitral valve or double valve replacement [15]. Patients were followed up for 24 months, and the incidence of mortality, thromboembolic and bleeding events did not differ from control group.…”

Section: Discussionmentioning

confidence: 99%

Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses

Zhang

Liu

et al. 2011

Cell Biochem Biophys

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The purpose of this study was to define the optimal international normalized ratio (INR) intensity of oral anticoagulant therapy in Chinese patients with valve replacement surgery. We studied 1,658 patients who underwent mechanical valve replacement in Beijing Anzhen Hospital; the focus of the study was on correlation between intensity of anticoagulant therapy and thromboembolism/hemorrhage complications. We further followed up 1,508 patients for 46 ± 16 months (range 1-61 months). Average INR was 2.13 ± 0.56, and warfarin dose was 3.09 ± 0.85 mg/day. The incidence rate of anticoagulation-related thromboembolism was 1.17 per 100 patient-years (%/pt-y), and the incidence rate of anticoagulation-related hemorrhage was 2.02%/pt-y. The incidence rate of total complications (i.e., combined thromboembolism and hemorrhages) was 3.24%/pt-y. The rate of total complications in group on INR 1.3-2.3 (aortic valve replacement: 1.3-1.8; mitral valve replacement and double valve replacement: 1.8-2.3) was the lowest among all anticoagulant therapy regimens followed. In conclusion, the relatively low anticoagulant strategy presented above efficiently prevents thrombosis and hemorrhage complications.

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Section: Discussionmentioning

confidence: 99%

Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses

Zhang

Liu

et al. 2011

Cell Biochem Biophys

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“…In western countries, Koertke et al [11] followed 1,137 German patients in a prospective, randomized, multicenter trial and demonstrated the efficacy and safety of very low, self-managed INR doses (INR target value, 2.0; range, 1.6–2.1) in patients with aortic valve replacement and 2.3 (range, 2.0–2.5) in patients with mitral valve or double valve replacement. In France, the AREVA study reported that the incidence of thromboembolic complications was similar in patients with a target INR range of 2.0–3.0 and those with a target INR range of 3.0–4.5; however, there were fewer bleeding complications in the low dose group [12].…”

Section: Discussionmentioning

confidence: 99%

The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement

Bal

Aydınalp

Yılmaz

et al. 2014

J Cardiothorac Surg

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BackgroundMechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0–2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy.MethodsOne hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n = 34), INR <2.0; group 2 (n = 49), INR 2.0–2.5; and group 3 (n = 52), INR >2.5.ResultsA total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P = 0.036).ConclusionsThis study showed that a target INRs of 2.0–2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR.

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“…In a study of patients with mechanical heart valves randomized to low-dose INR self-control [INR target range, AVR: 1.8-2.8; mitral valve replacement (MVR)/double INR: 2.5-3.5] or very low-dose INR self-control once a week and twice a week (INR target range, AVR: 1.6-2.1; MVR/double INR: 2.0-2.5), 2-year freedom from bleeding was lower in the very low-dose groups (96.3, 98.6, and 99.1%; P ¼ 0.008) [38]. There were no differences in thrombotic events (99.0, 99.8, and 98.9%, respectively; P ¼ 0.258).…”

Section: Low-dose Anticoagulation For Mechanical Prosthesesmentioning

confidence: 78%

Anticoagulation for prosthetic heart valves

Yanagawa

Whitlock

Verma

et al. 2016

Current Opinion in Cardiology

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Efficacy and Safety of Very Low-Dose Self-Management of Oral Anticoagulation in Patients With Mechanical Heart Valve Replacement

Cited by 42 publications

References 17 publications

Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses

Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses

The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement

Anticoagulation for prosthetic heart valves

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