Abstract
The purpose of this study was to define the optimal international normalized ratio (INR) intensity of oral anticoagulant therapy in Chinese patients with valve replacement surgery. We studied 1,658 patients who underwent mechanical valve replacement in Beijing Anzhen Hospital; the focus of the study was on correlation between intensity of anticoagulant therapy and thromboembolism/hemorrhage complications. We further followed up 1,508 patients for 46 ± 16 months (range 1–61 months). Average INR was 2.13 ± 0.56, and warfarin dose was 3.09 ± 0.85 mg/day. The incidence rate of anticoagulation-related thromboembolism was 1.17 per 100 patient-years (%/pt-y), and the incidence rate of anticoagulation-related hemorrhage was 2.02%/pt-y. The incidence rate of total complications (i.e., combined thromboembolism and hemorrhages) was 3.24%/pt-y. The rate of total complications in group on INR 1.3–2.3 (aortic valve replacement: 1.3–1.8; mitral valve replacement and double valve replacement: 1.8–2.3) was the lowest among all anticoagulant therapy regimens followed. In conclusion, the relatively low anticoagulant strategy presented above efficiently prevents thrombosis and hemorrhage complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Liu, Y., Meng, X., & Chen, B. (2001). Clinical results of the low intensity of oral anticoagulant therapy for patients with mechanical heart valve prostheses. Chinese Journal of Thoracic and Cardiovascular Surgery, 17, 163–265.
Acar, J., Iung, B., Boissel, J. P., Samama, M. M., Michel, P. L., Teppe, J. P., et al. (1996). AREVA: Multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves. Circulation, 94, 2107–2112.
Kayali, M. T., Fetieh, M. W., Abdulsalam, M. A., Memon, F., Moinuddin, M., & Raffa, H. (1998). Thrombotic obstruction of bileaflet mechanical prosthetic heart valves: Early diagnosis and management. The Journal of Cardiovascular Surgery (Torino), 39, 331–335.
Kalaria, V. G., Passannante, M. R., Shah, T., Modi, K., & Weisse, A. B. (1998). Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy. American Heart Journal, 135, 215–220.
Israel, D. H., Sharma, S. K., & Fuster, V. (1994). Antithrombotic therapy in prosthetic heart valve replacement. American Heart Journal, 127, 400–411.
Kontozis, L., Skudicky, D., Hopley, M. J., & Sareli, P. (1998). Long-term follow-up of St. Jude medical prosthesis in a young rheumatic population using low-level warfarin anticoagulation: An analysis of the temporal distribution of causes of death. American Journal of Cardiology, 81, 736–739.
Salem, D. N., Stein, P. D., Al-Ahmad, A., Bussey, H. I., Horstkotte, D., Miller, N., et al. (2004). Antithrombotic therapy in valvular heart disease—native and prosthetic: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126, 457S–482S.
You, J. H., Chan, F. W., Wong, R. S., & Cheng, G. (2005). Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? British Journal of Clinical Pharmacology, 59, 582–587.
Kudo, T., Kawase, M., Kawada, S., Kurosawa, H., Koyanagi, H., Takeuchi, Y., et al. (1999). Anticoagulation after valve replacement: A multicenter retrospective study. Artificial Organs, 23, 199–203.
Hirsh, J. (1992). Oral anticoagulant therapy. Urgent need for standardization. Circulation, 86, 1332–1335.
Gohlke-Barwolf, C., Acar, J., Burckhardt, D., Oakley, C., Butchart, E., Krayenbuhl, P., et al. (1993). Guidelines for prevention of thromboembolic events in valvular heart disease. Ad Hoc committee of the working group on valvular heart disease, European society of cardiology. Journal of Heart Valve Disease, 2, 398–410.
Cannegieter, S. C., Rosendaal, F. R., Wintzen, A. R., van der Meer, F. J., Vandenbroucke, J. P., & Briet, E. (1995). Optimal oral anticoagulant therapy in patients with mechanical heart valves. New England Journal of Medicine, 333, 11–17.
Eberlein, U., von der, E. J., Rein, J., & Esperer, H. D. (1990). Thromboembolic and bleeding complications after mitral valve replacement. European Journal of Cardio-Thoracic Surgery, 4, 605–612.
Horstkotte, D., Schulte, H. D., Bircks, W., & Strauer, B. E. (1994). Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude medical prosthesis. Journal of Thoracic and Cardiovascular Surgery, 107, 1136–1145.
Koertke, H., Zittermann, A., Wagner, O., Ennker, J., Saggau, W., Sack, F. U., et al. (2010). Efficacy and safety of very low-dose self-management of oral anticoagulation in patients with mechanical heart valve replacement. Annals of Thoracic Surgery, 90, 1487–1493.
Xu, Z., Zhang, B., Zhu, J., et al. (1995). Ten year follow-up of national home-made mitral mechanical valve replacement. Chinese Journal of Thoracic Cardiovascular Surgery, 11, 135.
Tang, B., Tong, C., Zhang, X., et al. (2004). Clinical research of international normalized ratio monitoring after mechanical heart valve replacement. Journal of Sun Yat-sen University of Medical Sciences, 19, 568–572.
Debetaz, L. F., Ruchat, P., Hurni, M., Fischer, A., Stumpe, F., Sadeghi, H., et al. (1997). St. Jude medical valve prosthesis: An analysis of long-term outcome and prognostic factors. Journal of Thoracic and Cardiovascular Surgery, 113, 134–148.
Author information
Authors and Affiliations
Corresponding author
Additional information
Zhang Haibao and Li Jinzhou are co-first authors of this paper.
Rights and permissions
About this article
Cite this article
Haibo, Z., Jinzhong, L., Yan, L. et al. Low-Intensity International Normalized Ratio (INR) Oral Anticoagulant Therapy in Chinese Patients with Mechanical Heart Valve Prostheses. Cell Biochem Biophys 62, 147–151 (2012). https://doi.org/10.1007/s12013-011-9275-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12013-011-9275-4