Outcomes of Patients with a Mechanical Heart Valve and Poor Anticoagulation Control on Warfarin
Why the study?
Patients with a mechanical heart valve require oral anticoagulation and poor control is thought to associate with adverse outcomes, but data are limited.
Does poor anticoagulation control (lower TTR) on warfarin increase the risk of thrombotic events, bleeding, and death in patients with a mechanical heart valve?
Population
671 consecutive patients undergoing MHV implantation at a tertiary care center
Comparison
Varying levels of time in therapeutic range (TTR) on warfarin beyond 90 days after surgery
Design
Retrospective cohort study
Follow-up
Median 4.9 years
Authors
Discussion
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Member takes
Implication
May warrant closer INR monitoring in MHV patients; leaves open whether targeted interventions improve outcomes in prospective trials.
Structured PICO
Does poor anticoagulation control (lower TTR) on warfarin increase the risk of thrombotic events, bleeding, and death in patients with a mechanical heart valve?
P
Population
671 consecutive patients undergoing mechanical heart valve (MHV) implantation at a tertiary care center (2010-2019), mean age 61 years, 30.3% female, 80.6% in aortic position, 14.6% in mitral position.
I
Intervention
Poor anticoagulation control on warfarin (measured as time in therapeutic range [TTR] beyond 90 days after surgery, specifically evaluating decrements in TTR or TTR <40%).
C
Comparator
Better anticoagulation control on warfarin (higher TTR, e.g., TTR >60%).
O
Outcome
Composite of ischemic stroke, systemic embolism, or prosthetic valve thrombosis.composite
In contemporary patients with mechanical heart valves, poor anticoagulation control on warfarin is strongly associated with increased risks of thrombotic events, major bleeding, and death.
Cite This Study
Johansson et al. (2023) studied this question.