International normalized ratio patient self-management for mechanical valves: is it safe enough?

Köerfer, Reiner; Reiss, Nils; Koertke, Heinrich

doi:10.1097/hco.0b013e328324e679

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…11,13 Six different centers across Germany participated in the ESCAT II study. 11,12 We included only patients from the Bad Oeynhausen center (881 patients) because this was the only center that had collected the detailed patient and perioperative information that we needed for our study. During patient selection for the propensity score analysis, we did not make a distinction between the 2 groups in the ESCAT II trial because there were no differences between the groups that were relevant for this study.…”

Section: Source Of Study Datamentioning

confidence: 99%

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Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy

et al. 2011

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Background-It is suggested that in young adults the Ross procedure results in better late patient survival compared with mechanical prosthesis implantation. We performed a propensity score-matched study that assessed late survival in young adult patients after a Ross procedure versus that after mechanical aortic valve replacement with optimal self-management anticoagulation therapy. Methods and Results-We selected 918 Ross patients and 406 mechanical valve patients 18 to 60 years of age without dissection, aneurysm, or mitral valve replacement who survived an elective procedure (1994 to 2008). With the use of propensity score matching, late survival was compared between the 2 groups. Two hundred fifty-three patients with a mechanical valve (mean follow-up, 6.3 years) could be propensity matched to a Ross patient (mean follow-up, 5.1 years). Mean age of the matched cohort was 47.3 years in the Ross procedure group and 48.0 years in the mechanical valve group (Pϭ0.17); the ratio of male to female patients was 3.2 in the Ross procedure group and 2.7 in the mechanical valve group (Pϭ0.46). Linearized all-cause mortality rate was 0.53% per patient-year in the Ross procedure group compared with 0.30% per patient-year in the mechanical valve group (matched hazard ratio, 1.86; 95% confidence interval, 0.58 to 5.91; Pϭ0.32). Late survival was comparable to that of the general German population. Conclusions-In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years. (Circulation. 2011;123:31-38.)

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Section: Source Of Study Datamentioning

confidence: 99%

“…11,12 The German-Dutch Ross Registry is a prospective multicenter cohort study with 1742 patients. Started in February 1991, the registry includes data from 12 cardiothoracic surgery departments in the Netherlands and Germany [7][8][9][10] (see the online-only Data Supplement for a list of participating centers).…”

Section: Source Of Study Datamentioning

confidence: 99%

Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy

et al. 2011

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“…Перспективным является обучение пациентов методам самотестирования и самоконтроля МНО с помощью портативных аппаратов [10,11], ис-пользование которых повышает приверженность к лечению и уменьшает частоту возникновения геморрагических и тромботических осложнений [12][13][14][15][16] в результате стабилизации целевого диа-пазона МНО [17,18].…”

Section: централизованная система контроля мноunclassified

Introduction of Centralized Inr Control in Kuzbass

Горбунова¹,

Макаров²,

Барбараш³

2016

Kompleks. probl. serdečno-sosud. zabol.

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Цель. Обосновать целесообразность внедрения системы централизованного контроля международного нормализованного отношения (МНО) в Кузбасском регионе.Анализ литературных данных свидетельствует, что централизованный контроль МНО увеличивает время нахождения в те-рапевтическом диапазоне, улучшает качество контроля, уменьшает частоту госпитализаций по причине кровотечений и тромбо-эмболий.Выводы. Организация антикоагулянтных кабинетов является экономически эффективной альтернативой лабораторного контроля МНО и может быть рекомендована для внедрения в практическое здравоохранение.Ключевые слова: централизованный контроль, международное нормализованное отношение, антикоагулянтный кабинет, экономическая эффективность. INTRODUCTION OF CENTRALIZED INR CONTROL IN KUZBASS E. V. GORBUNOVA, S. A. MAKAROV, O. L. BARBARASH Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases. Kemerovo, RussiaPurpose. Warfarin, an indirect anticoagulant, is commonly prescribed to patients who are at high risk for thrombotic complications. the achieved target hypocoagulation range allows to prevent thrombotic and hemorrhagic complications. Centralized international normalized ratio (INR) control increases the time in therapeutic range, improves quality control, reduces the rate of hospitalizations for bleeding and thromboembolism, suggesting its economic efficiency and allows to recommend this method of INR control for practical use. the current article presents the rationale for implementing centralized IRN control in the Kuzbass region in order to improve the efficiency and safety of ACt.

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“…We also searched for conference article (from ISI Web of Knowledge Platform of ISI Proceedings), unpublished degree dissertation (from ProQuest Digital Dissertations). Furthermore, relevant trials were identified through a manual search of secondary sources including references of initially identified articles and recent review articles [28]. Finally, a review of ClinicalTrials.gov was conducted to identify trials that may be eligible for inclusion.…”

Section: Search Strategymentioning

confidence: 99%

Two monitoring methods of oral anticoagulant therapy in patients with mechanical heart valve prothesis: a meta-analysis

Wang

et al. 2011

J Thromb Thrombolysis

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Oral anticoagulant therapy (OAT) with warfarin has become the standard therapy for the patients with mechanical heart valve prothesis. The monitoring method of self-monitoring or self-management was promising to optimize the use of warfarin, but most of previous studies have included patients with various indications of OAT, which made it difficult to extrapolate the results to the specific patient population with mechanical heart valve prostheses. This study was intended to evaluate the new and traditional monitoring methods in patients with mechanical heart valve prostheses. Relevant literature finished before Dec. 2010 were searched through a number of digital databases. And then they were pooled by RevMan 4.2 and R 2.13.0 in three fields: rate within the target range, test frequency and occurrence rate of poor events. Five randomized control trials with a total of 2,219 patients were identified. Pooled estimates showed reductions in thromboembolic events (OR 0.52, 95% CI 0.35-0.77; P = 0.0012) and all-cause mortality (OR 0.50, 95% CI 0.29-0.86; P = 0.0115). No difference was noted in major and minor haemorrhage. All trials reported improvements in the mean proportion of international normalized ratios in range. Self-monitoring and self-management can improve the quality of OAT in the patients with mechanical heart valve prostheses. The patients spend more time within the therapeutic range resulting in decreases in thromboembolic events and mortality, with no increase in haemorrhage. However, self-monitoring and self-management was not feasible for all patients, and require identification and education of suitable candidates. The success of self-monitoring and self-management method depends on consistent, regular, and frequent testing.

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International normalized ratio patient self-management for mechanical valves: is it safe enough?

Cited by 10 publications

References 10 publications

Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy

Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy

Introduction of Centralized Inr Control in Kuzbass

Two monitoring methods of oral anticoagulant therapy in patients with mechanical heart valve prothesis: a meta-analysis

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