Low-intensity Anticoagulation for Patients with Prosthetic Heart Valves in Northeast China: A Single-center Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHUZhi-cheng , LIDan , WANGTian-ce , XURi-hao , ZHANGShu-dong , WANGYong ,  LIUKe-xiang

Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun 130041, P. R. China;

Corresponding author：

LIUKe-xiang, Email: kxliu64@hotmail.com

Keywords：

Prosthetic heart valve; Follow-up study; Anticoagulation; Single-center

DOI：

10.7507/1007-4848.20140050

Video：

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Objective To explore optimal intensity of oral anticoagulation for patients with prosthetic heart valves in Northeast China. Methods A total of 856 patients in Northeast China who underwent prosthetic heart valve replacement in the Department of Cardiovascular Surgery,Second Hospital of Jilin University from January 2005 to June 2013 were enrolled in this study. There were 406 male and 450 female patients with their age of 45.2±13.3 years. All the patients received low-intensity oral anticoagulation [international normalized ratio (INR) 1.5-2.2,aortic valve replacement (AVR):1.5-1.8,mitral valve replacement (MVR):1.8-2.2]. Patients were followed up after discharge,and the incidence of anticoagulation-related complications was summarized. Results These patients were followed up for 1-78 (18.3±12.2) months,and the follow-up rate was 75.4%. Twelve patients (1.86%) had thromboembolic complications and 10 patients (1.55%) had hemorrhagic complications. Average warfarin dosage was 3.4±0.8 mg/day,and average INR was 1.94±0.54 during follow-up. Conclusion For patients with prosthetic heart valves in Northeast China,low-intensity anticoagulation can produce satisfactory clinical outcomes to reduce the incidence of anticoagulation-related thromboembolic or hemorrhagic complications.

Citation： ZHUZhi-cheng, LIDan, WANGTian-ce, XURi-hao, ZHANGShu-dong, WANGYong, LIUKe-xiang. Low-intensity Anticoagulation for Patients with Prosthetic Heart Valves in Northeast China: A Single-center Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 160-163. doi: 10.7507/1007-4848.20140050 Copy

1.	Romualdi E,Micieli E,Ageno W,et al.Oral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage.A systematic review.Thromb Haemost,2009,101 (2):290-297.
2.	Kayali MT,Fetieh MW,Abdulsalam MA,et al.Thrombotic obstruction of bileaflet mechanical prosthetic heart valves:early diagnosis and management.J Cardiovasc Surg (Torino),1998,39 (3):331-335.
3.	Salem DN,Stein PD,Al-Ahmad A,et al.Antithrombotic therapy in valvular heart disease--native and prosthetic:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest,2004,126 (3 Suppl):457S-482S.
4.	Yoganathan AP,Chandran KB,Sotiropoulos F,et al."Flow in prosthetic heart valves:state-of-the-art and future directions".Ann Biomed Eng,2005,33 (12):1689-1694.
5.	Kalaria VG,Passannante MR,Shah T,et al.Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy.Am Heart J,1998,135 (2 Pt 1):215-220.
6.	Hermans H,Vanassche T,Herijgers P,et al.Antithrombotic therapy in patients with heart valve prostheses.Cardiol Rev,2012,21 (1):27-36.
7.	Loke C,Ali SS,Johari V.Pharmacology of anticoagulants.Dis Mon,2012,58 (8):424-430.
8.	Hylek EM,Go AS,Chang Y,et al.Singer DE.Effect of the intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.N Engl J Med,2003,349 (11):1019-1026.
9.	Ansell J,Jacobson A,Levy J,et al.Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation.International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation.Int J Cardiol,2005,99 (1):37-45.
10.	Oake Natalie,Jennings A,Forster AJ,et al.Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy:a systematic review and meta-analysis.CMAJ,2008,179 (3):235-244.
11.	Cannegieter SC,Rosendaal FR,Wintzen AR,et al.Optimal oral anticoagulant therapy in patients with mechanical heart valves.N Eng J Med,1995,333 (1):11-17.
12.	Hirsh J.Oral anticoagulant therapy.Urgent need for standardization.Circulation,1992,86 (4):1332-1335.
13.	Koertke H,Zittermann A,Wagner O,et al.Efficacy and safety of very low-dose self-management of oral anticoagulation in patients with mechanical heart valve replacement.Ann Thorac Surg,2010,90 (5):1487-1493.
14.	Torella M,Torella D,Chiodini P,et al.LOWERing the INtensity of oral anticoaGulant Therapy in patients with bileaflet mechanical aortic valve replacement:results from the "LOWERING-IT" Trial.Am Heart J,2010,160 (1):171-178.
15.	Mori Takanobu,Asano M,Ohtake H,et al.Anticoagulant therapy after prosthetic valve replacement-optimal PT-INR in Japanese patients.Ann Thorac Cardiovasc Surg,2002,8 (2):83-87.
16.	Kudo T,Kawase M,Kawada S,et al.Anticoagulation after valve replacement:a multicenter retrospective study.Artif Organs,1999,23 (2):199-203.
17.	徐志云,张宝仁,朱家麟,等.国产侧倾碟瓣二尖瓣替换10年以上随访.中华胸心血管外科杂志,1995,11 (3):135-137,190.
18.	孟旭,李金钟,刘岩,等.人工机械瓣膜置换术后口服抗凝药的抗凝治疗强度标准.中华心血管病杂志,2004,32 (7):618-621.
19.	Zhang HB,Li JZ,Liu Y,et al.Low-intensity international normalized ratio (INR) oral anticoagulant therapy in Chinese patients with mechanical heart valve prostheses.Cell Biochem Biophys,2012,62 (1):147-151.
20.	刘媛,余细勇,钟诗龙,等.心脏瓣膜置换术后华法林抗凝治疗的单中心临床应用调查.南方医科大学学报,2010,30 (10):2242-2245.

1. Romualdi E,Micieli E,Ageno W,et al.Oral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage.A systematic review.Thromb Haemost,2009,101 (2):290-297.
2. Kayali MT,Fetieh MW,Abdulsalam MA,et al.Thrombotic obstruction of bileaflet mechanical prosthetic heart valves:early diagnosis and management.J Cardiovasc Surg (Torino),1998,39 (3):331-335.
3. Salem DN,Stein PD,Al-Ahmad A,et al.Antithrombotic therapy in valvular heart disease--native and prosthetic:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest,2004,126 (3 Suppl):457S-482S.
4. Yoganathan AP,Chandran KB,Sotiropoulos F,et al."Flow in prosthetic heart valves:state-of-the-art and future directions".Ann Biomed Eng,2005,33 (12):1689-1694.
5. Kalaria VG,Passannante MR,Shah T,et al.Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy.Am Heart J,1998,135 (2 Pt 1):215-220.
6. Hermans H,Vanassche T,Herijgers P,et al.Antithrombotic therapy in patients with heart valve prostheses.Cardiol Rev,2012,21 (1):27-36.
7. Loke C,Ali SS,Johari V.Pharmacology of anticoagulants.Dis Mon,2012,58 (8):424-430.
8. Hylek EM,Go AS,Chang Y,et al.Singer DE.Effect of the intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.N Engl J Med,2003,349 (11):1019-1026.
9. Ansell J,Jacobson A,Levy J,et al.Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation.International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation.Int J Cardiol,2005,99 (1):37-45.
10. Oake Natalie,Jennings A,Forster AJ,et al.Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy:a systematic review and meta-analysis.CMAJ,2008,179 (3):235-244.
11. Cannegieter SC,Rosendaal FR,Wintzen AR,et al.Optimal oral anticoagulant therapy in patients with mechanical heart valves.N Eng J Med,1995,333 (1):11-17.
12. Hirsh J.Oral anticoagulant therapy.Urgent need for standardization.Circulation,1992,86 (4):1332-1335.
13. Koertke H,Zittermann A,Wagner O,et al.Efficacy and safety of very low-dose self-management of oral anticoagulation in patients with mechanical heart valve replacement.Ann Thorac Surg,2010,90 (5):1487-1493.
14. Torella M,Torella D,Chiodini P,et al.LOWERing the INtensity of oral anticoaGulant Therapy in patients with bileaflet mechanical aortic valve replacement:results from the "LOWERING-IT" Trial.Am Heart J,2010,160 (1):171-178.
15. Mori Takanobu,Asano M,Ohtake H,et al.Anticoagulant therapy after prosthetic valve replacement-optimal PT-INR in Japanese patients.Ann Thorac Cardiovasc Surg,2002,8 (2):83-87.
16. Kudo T,Kawase M,Kawada S,et al.Anticoagulation after valve replacement:a multicenter retrospective study.Artif Organs,1999,23 (2):199-203.
17. 徐志云,张宝仁,朱家麟,等.国产侧倾碟瓣二尖瓣替换10年以上随访.中华胸心血管外科杂志,1995,11 (3):135-137,190.
18. 孟旭,李金钟,刘岩,等.人工机械瓣膜置换术后口服抗凝药的抗凝治疗强度标准.中华心血管病杂志,2004,32 (7):618-621.
19. Zhang HB,Li JZ,Liu Y,et al.Low-intensity international normalized ratio (INR) oral anticoagulant therapy in Chinese patients with mechanical heart valve prostheses.Cell Biochem Biophys,2012,62 (1):147-151.
20. 刘媛,余细勇,钟诗龙,等.心脏瓣膜置换术后华法林抗凝治疗的单中心临床应用调查.南方医科大学学报,2010,30 (10):2242-2245.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Low-intensity Anticoagulation for Patients with Prosthetic Heart Valves in Northeast China: A Single-center Study

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