Why the study?
Little is known about the success of required VKA treatment and its relation to adverse events after mechanical AVR in patients with AF.
Does lower Time in Therapeutic Range (TTR) during Vitamin K Antagonist treatment increase the risk of ischemic stroke, bleeding, and mortality in patients with atrial fibrillation and mechanical aortic valve replacement?
Population
1086 mechanical AVR patients with AF without prior bleeding, ischemic stroke, or MI
Comparison
Quality of VKA treatment prior to adverse events
Design
Nationwide registry-based cohort study
Follow-up
10 years
Key result
Lower mean Time in Therapeutic Range was associated with a higher risk of ischemic stroke (HR 1.23; 95% CI 1.03-1.49; p=0.030) in patients with atrial fibrillation and mechanical AVR.
Authors
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Suboptimal TTR identifies high-risk patients for bleeding, stroke, and death after mechanical AVR with AF; leaves open whether TTR optimization reduces events.
Cohort (n=1,086)
Yes
Does lower Time in Therapeutic Range (TTR) during Vitamin K Antagonist treatment increase the risk of ischemic stroke, bleeding, and mortality in patients with atrial fibrillation and mechanical aortic valve replacement?
Hazard Ratio: 1.23 (95% CI 1.03–1.49)
p-value: p=0.030
In patients with atrial fibrillation and mechanical aortic valve replacement, suboptimal time in therapeutic range on vitamin K antagonists is associated with increased risks of ischemic stroke, bleeding, and mortality.
Lehto et al. (2023) conducted a cohort in Atrial fibrillation and mechanical aortic valve replacement (n=1,086). Lower mean Time in Therapeutic Range (TTR) vs. Higher mean TTR was evaluated on First-ever ischemic stroke (HR 1.23, 95% CI 1.03-1.49, p=0.030). Lower mean Time in Therapeutic Range was associated with a higher risk of ischemic stroke (HR 1.23; 95% CI 1.03-1.49; p=0.030) in patients with atrial fibrillation and mechanical AVR.