Key result
Less frequent PT-INR monitoring linked to ~231% higher risk of major events versus frequent monitoring.
Why the study?
The correlation between PT-INR monitoring frequency and long-term prognosis after discharge in patients with mechanical heart valve replacement was not established.
Does frequent PT-INR monitoring (≤ 1 month) reduce the composite of thromboembolic event, major bleeding, or all-cause death in patients with mechanical heart valve replacement?
Observational (n=188)
No
Does frequent PT-INR monitoring (≤ 1 month) reduce the composite of thromboembolic event, major bleeding, or all-cause death in patients with mechanical heart valve replacement?
Hazard Ratio: 3.31 (95% CI 1.05–10.42)
Absolute Event Rate: 3.74% vs 1.16%
p-value: p=0.041
Frequent PT-INR monitoring (≤ 1 month) in patients with mechanical heart valves is associated with a significantly lower risk of thromboembolic events, major bleeding, and all-cause death compared to less frequent monitoring.
May support more frequent PT-INR monitoring in practice; hypothesis-generating and requires randomized confirmation before changing guidelines.
BACKGROUND: The study aimed to assess the correlation between the monitoring frequency of PT-INR and the long-term prognosis in patients with mechanical heart valve (MHV) replacement after discharge. METHODS: This single-center, observational study enrolled patients who underwent MHV replacement and discharged from June 2015 to May 2018. Patients or their corresponding family members were followed with a telephone questionnaire survey in July-October 2020. Based on monitoring intervals, patients were divided into frequent monitoring (FM) group (≤ 1 month) and less frequent monitoring (LFM) group (> 1 month). The primary endpoint was the composite of thromboembolic event, major bleeding or all-cause death. The secondary endpoints were thromboembolic event, major bleeding or all-cause death, respectively. RESULTS: A total of 188 patients were included in the final analysis. The median follow-up duration was 3.6 years (Interquartile range: 2.6 to 4.4 years). 104 (55.3%) patients and 84 (44.7%) patients were classified into the FM group and the LFM group, respectively. The FM group had a significantly lower incidence of the primary endpoint than the LFM group (3.74 vs. 1.16 per 100 patient-years, adjusted HR: 3.31 [95% CI 1.05-10.42, P = 0.041]). Secondary analysis revealed that the risk of thromboembolic events and all-cause death were also reduced in the FM group. CONCLUSIONS: The management of warfarin treatment in patients after MHV replacement remains challenging. Patients with less frequent monitoring of PT-INR might have worse clinical prognosis than those with frequent PT-INR monitoring.
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Geng et al. (2023) conducted an observational in Mechanical heart valve replacement (n=188). Less frequent monitoring of PT-INR (> 1 month) vs. Frequent monitoring of PT-INR (≤ 1 month) was evaluated on Composite of thromboembolic event, major bleeding or all-cause death (HR 3.31, 95% CI 1.05-10.42, p=0.041). Less frequent monitoring of PT-INR (> 1 month) was associated with a significantly higher risk of thromboembolic events, major bleeding, or all-cause death compared to frequent monitoring (HR 3.31).
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