What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic valve replacement (n=909). Intervention: Low-INR anticoagulation (INR 1.5-2.5) vs. Standard anticoagulation (INR 2.5-3.5). Primary outcome: 15-year survival (p=<0.001).

February 28, 2017Interactive Cardiovascular and Thoracic SurgeryOpen Access

Low 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 anticoagulation

Q: What are the key findings of this study?

A low-INR anticoagulation strategy (1.5-2.5) in selected aortic valve replacement patients was associated with significantly better 15-year survival compared to standard INR (63% vs 34%, P<0.001).

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Key result

A low-INR anticoagulation strategy (1.5-2.5) in selected aortic valve replacement patients was associated with significantly better 15-year survival compared to standard INR (63% vs 34%, P<0.001).

Why the study?

Does low-INR anticoagulation improve survival and reduce valve-related events compared to standard anticoagulation in selected patients after aortic valve replacement with a mechanical prosthesis?

Population

909 patients after single aortic valve replacement with the Medtronic Open Pivot mechanical heart valve. The…

Comparison

Low-INR anticoagulation (target INR 1.5-2.5) vs Standard anticoagulation (target INR 2.5-3.5)

Design

Cohort

Follow-up

up to 15 years (cumulating 3096 patient-years)

Authors

TBThierry BovéGhent University Hospital YBYves Van BelleghemGhent University Hospital KFKatrien FrançoisGhent University Hospital

Discussion

Member takes

Implication

Supports low-INR targets in selected mechanical AVR patients; leaves open randomized confirmation before practice change.

Study Design

Type

Cohort (n=909)

Structured PICO

Does low-INR anticoagulation improve survival and reduce valve-related events compared to standard anticoagulation in selected patients after aortic valve replacement with a mechanical prosthesis?

Population

909 patients with preserved sinus rhythm and left ventricular function who underwent single aortic valve replacement with a mechanical valve, followed for up to 20 years.

Exposure

Low-INR anticoagulation (target INR 1.5-2.5)

Comparator

Standard anticoagulation (target INR 2.5-3.5)

Outcome

Long-term survival and valve-related events (thromboembolic rate and bleeding incidence)hard clinical

Main Result

Absolute Event Rate: 63% vs 34%

p-value: p=<0.001

A low-INR anticoagulation strategy (1.5-2.5) in selected patients with a mechanical aortic valve is safe, reducing bleeding without increasing thromboembolic events, and is associated with improved long-term survival.

Cite This Study

Bové et al. (2017) conducted a cohort in Aortic valve replacement (n=909). Low-INR anticoagulation (INR 1.5-2.5) vs. Standard anticoagulation (INR 2.5-3.5) was evaluated on 15-year survival (p=<0.001). A low-INR anticoagulation strategy (1.5-2.5) in selected aortic valve replacement patients was associated with significantly better 15-year survival compared to standard INR (63% vs 34%, P<0.001).

synapsesocial.com/papers/6a9adf95c2f95c37527bc190 https://doi.org/10.1093/icvts/ivx028

Topics

Valvular heart disease Anticoagulation in AF

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February 28, 2017Interactive Cardiovascular and Thoracic SurgeryOpen Access

Low 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 anticoagulation

View Full Paper

Ask AI

Bookmark

Key result

A low-INR anticoagulation strategy (1.5-2.5) in selected aortic valve replacement patients was associated with significantly better 15-year survival compared to standard INR (63% vs 34%, P<0.001).

Why the study?

Does low-INR anticoagulation improve survival and reduce valve-related events compared to standard anticoagulation in selected patients after aortic valve replacement with a mechanical prosthesis?

Population

909 patients after single aortic valve replacement with the Medtronic Open Pivot mechanical heart valve. The…

Comparison

Low-INR anticoagulation (target INR 1.5-2.5) vs Standard anticoagulation (target INR 2.5-3.5)

Design

Cohort

Follow-up

up to 15 years (cumulating 3096 patient-years)

Authors

TBThierry BovéGhent University Hospital YBYves Van BelleghemGhent University Hospital KFKatrien FrançoisGhent University Hospital

Discussion

Member takes

Implication

Supports low-INR targets in selected mechanical AVR patients; leaves open randomized confirmation before practice change.

Study Design

Type

Cohort (n=909)

Structured PICO

Does low-INR anticoagulation improve survival and reduce valve-related events compared to standard anticoagulation in selected patients after aortic valve replacement with a mechanical prosthesis?

Population

909 patients with preserved sinus rhythm and left ventricular function who underwent single aortic valve replacement with a mechanical valve, followed for up to 20 years.

Exposure

Low-INR anticoagulation (target INR 1.5-2.5)

Comparator

Standard anticoagulation (target INR 2.5-3.5)

Outcome

Long-term survival and valve-related events (thromboembolic rate and bleeding incidence)hard clinical

Main Result

Absolute Event Rate: 63% vs 34%

p-value: p=<0.001

Cite This Study

synapsesocial.com/papers/6a9adf95c2f95c37527bc190 https://doi.org/10.1093/icvts/ivx028

Also Consider

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

Topics

Valvular heart disease Anticoagulation in AF

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