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[Anticoagulation in chinese patients with carbomedics mechanical prosthetic heart valves]
Wei Zhuang1, Xin-Min Zhou, Jian-Guo Hu
1Department of Cardiothoracic Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China. zhuangwei1005@163.com
Insights
For Chinese patients receiving mechanical heart valves, a lower anticoagulation intensity (INR 1.4-2.0) effectively reduces bleeding complications while preventing clots. Close monitoring in the first month post-operation is crucial for stable INR levels.
Area of Science:
- Cardiology
- Biomedical Engineering
- Pharmacology
Context:
- Mechanical heart valve prostheses require lifelong anticoagulation therapy.
- Optimal anticoagulation intensity is crucial to balance bleeding and thromboembolic risks.
- Previous studies have not definitively established optimal anticoagulation targets for Chinese populations.
Purpose:
- To determine the optimal intensity of anticoagulation for Chinese patients with mechanical heart valve prostheses.
- To compare complication rates (hemorrhage and thromboembolism) at a target INR of 1.4-2.0.
- To analyze INR variations during follow-up periods.
Summary:
- A study of 178 patients with Carbomedics mechanical valves found hemorrhage (5.83%) to be more common than thromboembolism (0.26%) at a target INR of 1.4-2.0.
- The final mean INR was 1.68 ± 0.38, with the highest INR instability observed in the first month post-operation.
- Low-dose anticoagulation (INR 1.4-2.0) effectively reduced hemorrhagic events and prevented thromboembolic events.
Impact:
- This research provides evidence-based recommendations for anticoagulation management in Chinese patients with mechanical heart valves.
- Highlights the importance of intensive INR monitoring during the critical first month after valve replacement.
- Aims to improve patient outcomes by minimizing anticoagulant-related complications.
Objective:
To provide some references for defining the Chinese optimal intensity of anticoagulation after mechanical heart valve prostheses replacement.
Methods:
For the 178 patients with carbomedics mechanical prosthetic heart valves, the means of INR were compared between the patients with complications and those without complications at the standard of INR1. 4 - 2.0. Also, the variations of INR were compared among different follow-ups.
Results:
During the follow-up, 22 hemorrhagic and 1 thromboembolic complication occurred. The total linearized rate of anticoagulation-related hemorrhage was 5.83% pty. The total linearized rate thromboembolism was 0.26% pty. The late mortality was 0.79% pty (3 cases ). The final mean INR was 1.68 +/- 0.38. The final mean oral warfarin dose was 2.34 +/- 0.80 mg. The differences of variations of INR in five periods were significant (F = 5.072, P < 0.05). The mean INR in the first month of follow-up was 1.75 +/- 0.27.
Conclusion:
For Chinese patients with mechanical prosthetic heart valve, hemorrhage is the principal complication, the ratio of which is much higher than that of thromboembolism. The low-dose anticoagulation (INR1. 4-2.0) could remarkably decrease hemorrhagic events as effectively as prevent the thrombolic events. Moreover the INR is the most unstable in the first month of follow-up, so re-examination for the patients in the first month after the operation is vitally important.
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