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Related Experiment Videos

Anticoagulation variability between centres: implications for comparative prosthetic valve assessment.

E G Butchart1, P A Lewis, E N Kulatilake

  • 1Department of Cardiac Surgery, University Hospital of Wales, Cardiff, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1988
PubMed
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Anticoagulation variability significantly impacts thromboembolic rates in mechanical prosthetic valve patients. Standardizing anticoagulant practice internationally is crucial for comparing complication data and ensuring prosthesis validity.

Area of Science:

  • Cardiovascular Surgery
  • Clinical Pharmacy
  • Biomedical Engineering

Background:

  • Thromboembolic (TE) rates are critical for mechanical prosthetic valve selection.
  • Anticoagulation levels significantly influence observed TE rates.
  • Variability in anticoagulation control can confound study results.

Purpose of the Study:

  • To investigate anticoagulation variability in patients with Medtronic-Hall mechanical prosthetic valves.
  • To assess the range of International Normalised Ratio (INR) preferences among UK cardiac surgeons.
  • To highlight the impact of anticoagulation variability on TE complication data.

Main Methods:

  • A retrospective study of 834 patients with Medtronic-Hall prostheses over 7 years (1979-1987).
  • Analysis of 16,866 INR observations from 27 different anticoagulant clinics.

Related Experiment Videos

  • A national questionnaire survey of 89 UK cardiac surgeons regarding preferred INR ranges.

    • Main Results:

    • Significant variability in median INR values (2.2-3.9) across anticoagulant clinics.
    • Wide range of preferred INR values among UK surgeons (1.8-2.2 to 3.0-4.8), with 64% favoring <3.0.
    • Discrepancy noted with standard US practice (INR 4.0-5.0).

    Conclusions:

    • Enormous variability exists in anticoagulation practice and surgeon preferences.
    • International standardization of anticoagulation is essential for meaningful comparison of TE complication rates.
    • TE rates for specific prostheses are questionable without detailed anticoagulant control analysis.