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[The target value of anticoagulation intensity for Chinese patients after mechanical heart valve replacement]

L Dong1, J P Xu2, D Zhu1

  • 1Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.

Zhonghua Yi Xue Za Zhi
|August 14, 2023
PubMed

Insights

For Chinese patients receiving mechanical heart valve replacement, a target International Normalized Ratio (INR) of 1.5-2.5 is recommended. Lower INR ranges (1.5-2.0) are optimal for low-risk aortic or mitral valve replacement patients, while higher ranges (2.0-2.5) suit others.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Pharmacology
  • Biomedical Engineering

Background:

  • Mechanical heart valve replacement necessitates effective anticoagulation to prevent thromboembolic events.
  • Determining the optimal intensity of anticoagulation, measured by International Normalized Ratio (INR), is crucial for patient outcomes.
  • Previous guidelines may not fully address the specific needs of Chinese patient populations post-valve replacement.

Purpose of the Study:

  • To identify the optimal target International Normalized Ratio (INR) range for anticoagulation therapy in Chinese patients following mechanical heart valve replacement.
  • To compare anticoagulation-related complication rates across different INR intensities in this specific patient cohort.
  • To provide evidence-based recommendations for anticoagulation management tailored to Chinese patients.

Main Methods:

  • Prospective, multicenter cohort study analyzing data from 35 medical centers in China.
  • Inclusion of data from in-hospital and outpatient clinic patients between January 2011 and December 2015.
  • Analysis of anticoagulation-related complications in relation to varying INR levels, including specific subgroups like aortic valve replacement (AVR), mitral valve replacement (MVR), and double valve replacement (DVR).

Main Results:

  • A total of 24,433 patients were analyzed, with a median follow-up of 19.2 months.
  • Patients with an INR range of 1.5-2.5 exhibited significantly lower rates of anticoagulation-related complications (0.65/100 patient-years) compared to those with INR < 1.5 (1.31/100 patient-years) or INR > 2.5 (2.34/100 patient-years).
  • Specific optimal INR ranges were identified: 1.5-2.0 for low-risk isolated AVR or MVR, and 2.0-2.5 for high-risk AVR/MVR, tricuspid valve replacement (TVR), or DVR.

Conclusions:

  • A target INR range of 1.5-2.5 is recommended for Chinese patients after mechanical heart valve replacement.
  • Tailored INR targets based on valve type and patient risk factors can further optimize anticoagulation therapy and minimize complications.
  • These findings support individualized anticoagulation strategies for improved safety and efficacy in this population.

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