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Anticoagulation for valvular heart disease in community-based practice

A J Rose1, A Ozonoff, L E Henault

  • 1Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, 200 Springs Road, Building 70, Bedford, MA 01730, USA. adamrose@bu.edu

Thrombosis and Haemostasis
|December 22, 2009
PubMed

Insights

Patients on oral anticoagulation for valvular heart disease (VHD) had similar blood thinner control but a higher risk of major bleeding compared to those with atrial fibrillation (AF). Further research is needed to understand this increased bleeding risk in VHD patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Oral anticoagulation is crucial for valvular heart disease (VHD) and atrial fibrillation (AF).
  • Limited data exists on VHD patients receiving anticoagulation in community settings.
  • Understanding VHD anticoagulation management and outcomes is vital for patient care.

Purpose of the Study:

  • To characterize patients anticoagulated for VHD compared to AF.
  • To assess management and clinical outcomes in these patient groups.
  • To identify differences in anticoagulation control and bleeding events.

Main Methods:

  • Utilized a nationally-representative US cohort of community-based anticoagulation care.
  • Collected data on indications, demographics, comorbidities, INR targets, INR control, and outcomes.
  • Compared 1,057 VHD patients with 3,396 AF patients.

Main Results:

  • VHD patients constituted 15.6% of the anticoagulated cohort.
  • INR variability was similar between VHD and AF groups (0.64 vs. 0.69).
  • VHD patients experienced a higher rate of major hemorrhage (3.57 vs. 1.78 events/100 patient-years).
  • Stroke/systemic embolus rates were similar between groups (0.67 vs. 0.97 events/100 patient-years).
  • A majority of aortic VHD patients (84%) were on a higher INR target range (2.5-3.5) than recommended (2-3).

Conclusions:

  • Community-based anticoagulation for VHD is common, representing 15.6% of patients.
  • Anticoagulation control, measured by INR variability, is comparable between VHD and AF patients.
  • VHD patients exhibit a significantly higher rate of major hemorrhage, warranting further investigation.
  • Discrepancies in target INR ranges for aortic VHD suggest potential management issues.

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