Key result
Higher INR levels are linked to hemorrhage in elderly patients after cardiac valve replacement.
Why the study?
The target international normalized ratio value for warfarin treatment after cardiac valve replacement remains to be determined.
Does warfarin dosage and INR level correlate with hemorrhage or embolism in elderly patients after cardiac valve replacement?
Observational (n=213)
No
Does warfarin dosage and INR level correlate with hemorrhage or embolism in elderly patients after cardiac valve replacement?
p-value: p=<0.001
Higher warfarin dosages and resulting higher INR/PT are significantly associated with hemorrhagic complications in elderly patients following cardiac valve replacement.
May support cautious INR monitoring in elderly post-valve patients; leaves optimal targets open for randomized trials.
Thus far, the target value for international normalized ratio (INR) has remained to be determined. The current study aimed to further explore the INR value of the anti-coagulation drug warfarin after cardiac valve replacement. The clinical data of 213 patients who underwent cardiac valve replacement at Linyi Central Hospital (Linyi, China) between January 2010 and May 2013 were retrospectively analyzed. The warfarin dosage, prothrombin time (PT) and INR were compared among patients with hemorrhage or embolism, and those with no complications. A total of 31 cases (14.6%) developed adverse reactions and complications during the medication period, including 21 cases with hemorrhage (9.9%, hemorrhage group) and 10 cases with embolism (4.7%, embolism group), while 182 patients did not (85.4%, normal group). The average dosage of warfarin was 2.0±0.6, 3.1±0.7 and 1.7±0.6 mg/day in the normal, hemorrhage and embolism groups, respectively. The dosage of warfarin, the PT and the INR in the hemorrhage group were all significantly greater than those in the normal group and the embolism group (all P<0.05). INR monitoring is recommended to ensure the safety of the anti-coagulant drug warfarin, but further study is still required to determine a reasonable target INR value.
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Ma et al. (2018) conducted an observational in Cardiac valve replacement (n=213). Warfarin vs. Patients with no complications (normal group) was evaluated on Differences in INR among patients with hemorrhage, embolism, or no complications at 6 months (p=<0.001). In elderly patients after cardiac valve replacement, those who experienced hemorrhage had significantly higher INR levels (2.6±0.7) compared to those with no complications (1.9±0.6) or embolism (1.5±0.7) (P<0.001).
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