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September 9, 2003Circulation

INR Self-Management Permits Lower Anticoagulation Levels After Mechanical Heart Valve Replacement

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Why the study?

Does a lower INR target range with self-management reduce complication rates in patients after mechanical heart valve replacement?

Population

1,818 patients after mechanical heart valve replacement.

Comparison

Low-dose INR target range with early onset INR… vs Conventional INR target range with INR…

Design

RCT, randomized

Authors

HKHeinrich KoertkeHeart and Diabetes Center North Rhine-WestphaliaKMKazutomo MinamiNihon UniversityDBDietmar BoethigMedizinische Hochschule Hannover

Discussion

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Overview

Supports lower INR targets with self-management after mechanical valve replacement; confirms bleeding reduction without thromboembolism increase.

Structured PICO

Does a lower INR target range with self-management reduce complication rates in patients after mechanical heart valve replacement?

P
Population
1,818 patients (interim analysis of a planned 3,300) after mechanical heart valve replacement (St. Jude Medical Standard or Medtronic Hall).
I
Intervention
Low-dose INR target range (INR 1.8 to 2.8 for prostheses in aortic position and 2.5 to 3.5 for prostheses in mitral position or in combined valve replacement) with early onset INR self-management under oral anticoagulation.
C
Comparator
Conventional INR target range (INR 2.5 to 4.5 for all valve positions) with INR self-management.
O
Outcome
Complication rates (thromboembolism and bleeding).hard clinical

A lower INR target range for self-managed patients with mechanical heart valves reduces bleeding complications without increasing the risk of thromboembolic events.

Cite This Study

Koertke et al. (2003) studied this question.

synapsesocial.com/papers/6a6f7df65d37378ac1dc8ceahttps://doi.org/10.1161/01.cir.0000089185.80318.3f

Topics

Anticoagulation in AF
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1International normalized ratio patient self-management for mechanical valves: is it safe enough?2009 · 10 citations
  2. 2Telemedicine-guided, very low-dose international normalized ratio self-control in patients with mechanical heart valve implants2014 · 49 citations
  3. 3Low-dose oral anticoagulation in patients with mechanical heart valve prostheses: final report from the early self-management anticoagulation trial II2007 · 94 citations
  4. 4Mechanical heart valve patients can manage oral anticoagulant therapy themselves2003 · 45 citations
  5. 5Low target-INR anticoagulation is safe in selected aortic valve patients with the Medtronic Open Pivot mechanical prosthesis: long-term results of a propensity-matched comparison with standard anticoagulation2017 · 13 citations