Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGJin-hua ¹ , GUANChao-fan ¹ , CHENZhi-jie ² , TIANHuang-long ¹ ,  CAOHua ³

1. Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, China;
2. Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China;
3. Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China;

Corresponding author：

CAOHua, Email: caohua69@hotmail.com

Keywords：

Mechanical heart valve replacement; Warfarin; Anticoagulation intensity; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20140219

Video：

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Objective To systematically review therapy-related complications incidences of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement, and to explore the suitable anticoagulation intensity of warfarin. Methods We electronically searched The Cochrane Library (Issue 2, 2013), EMbase, PubMed, CNKI, CBM, WanFang Data and VIP for studies about therapy-related complications rates of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement from inception to March 2013. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 7 studies involving 3 787 cases were finally included, 2 985 cases in Group A (targeted INR≤2.3) and 802 cases in Group B (targeted INR > 2.3). The results of meta-analysis showed that, compared with Group B, the total therapy-related complications incidence of warfarin with different anticoagulation intensity significantly decreased in Group A (OR=0.35, 95%CI 0.28 to 0.44, P < 0.000 01). The incidence of hemorrhage in Group A (OR=0.15, 95%CI 0.08 to 0.27, P < 0.000 01) was lower than that in Group B. However, the incidence of embolism in Group A was higher than that in Group B (OR=2.77, 95%CI 1.54 to 4.98, P=0.000 7). Conclusion Applying low-intensity anticoagulation for Chinese patients after mechanical heart valve replacement could reduce the overall incidences of anticoagulation-related complications and hemorrhage, but it could also significantly increase the incidence of thrombosis.

Citation： ZHANGJin-hua, GUANChao-fan, CHENZhi-jie, TIANHuang-long, CAOHua. Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1361-1366. doi: 10.7507/1672-2531.20140219 Copy

1.	Stein PD, Alpert JS, Bussey HI, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 2001, 119(1 Suppl):220S-227S.
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.	张进华, 刘茂柏, 官超凡, 等.网上抗凝门诊的建立与实践.中国药学杂志, 2014, 49(16):99-101.
4.	Wigle P, Hein B, Bloomfield HE, et al. Updated guidelines on outpatient anticoagulation. Am Fam Physician, 2013, 87(8):556-566.
5.	Lee MT, Klein TE. Pharmacokinetics of warfarin:challenges and opportunities. J Hum Genet, 2013, 58(6):334-338.
6.	Wallace JL, Reaves AB, Tolley EA, et al. Comparison of initial warfarin response in obese patients versus non-obese patients. J Thromb Thrombolysis, 2013, 36(1):96-101.
7.	王斌, 徐志云, 叶小飞.华人心脏机械瓣膜置换术后华法林抗凝强度标准的系统评价.国际心血管病杂志, 2011, 37(6):361-365.
8.	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-660.
9.	刘文平, 黄彩云.国产奥美拉唑治疗急性非静脉曲张性上消化道出血的Meta分析.中国循证医学杂志, 2013, 13(6):723-727.
10.	杨莉萍, 谢婧, 刘瑶, 等. CYP2C19^2、^3基因多态性与氯吡格雷临床疗效相关性的系统评.中国循证医学杂志, 2012, 12(9):1063-1070.
11.	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.
12.	王志伟, 徐明星, 计乐群.心脏瓣膜置换术后低强度抗凝研究.中华实验外科杂志, 2005, 22(4):484-485.
13.	王胜鹏, 王忠明.云南地区瓣膜置换术后低强度抗凝的临床研究.硕士学位论文.云南:昆明医学院, 2007.
14.	俞经生, 葛建军, 周正春.心脏瓣膜置换术后抗凝治疗的临床研究.安徽医药, 2008, 12(9):820-821.
15.	白银, 方刚.宁夏地区机械瓣膜置换术后抗凝治疗的回顾分析.宁夏回族自治区:宁夏医科大学, 2011.
16.	郝占平, 唐英杰, 丁敏, 等.机械心脏瓣膜置换术后远期抗凝状态临床观察及意义.陕西医学杂志, 2011, 40(7):827-828.
17.	徐博, 刘金城, 俞世强, 等.人工机械心脏瓣膜置换术后抗凝治疗强度与并发症发生率的关系.心脏杂志, 2012, 24(6):749-752.
18.	Karl H, Gulshan KS, William GH, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4):1152-1158.
19.	Sand ME, Naftel DC, Blackstone EH, et al. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg, 1987, 94(2):208-219.
20.	Claiborne TE, Xenos M, Sheriff J, et al. Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation. ASAIO J, 2013, 59(3):275-283.
21.	Alexander GG, Jack H, John G, et al. Randomized comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet, 1998, 331(8597):1242-1245.
22.	Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease:Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl):e576S-600S.
23.	Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 2011, 365(21):2002-2012.
24.	Wofford JL, Wells MD, Singh S. Best strategies for patient education about anticoagulation with warfarin:a systematic review. BMC Health Serv Res, 2008, 14(8):40.
25.	Baker JW, Pierce KL, Ryals CA. INR goal attainment and oral anticoagulation knowledge in an anticoagulation clinic in a Veterans Affairs medical center. J Manag Care Pharm, 2011, 17(2):133-142.
26.	Garton L, Crosby JF. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis, 2011, 32(4):426-430.

1. Stein PD, Alpert JS, Bussey HI, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 2001, 119(1 Suppl):220S-227S.
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. 张进华, 刘茂柏, 官超凡, 等.网上抗凝门诊的建立与实践.中国药学杂志, 2014, 49(16):99-101.
4. Wigle P, Hein B, Bloomfield HE, et al. Updated guidelines on outpatient anticoagulation. Am Fam Physician, 2013, 87(8):556-566.
5. Lee MT, Klein TE. Pharmacokinetics of warfarin:challenges and opportunities. J Hum Genet, 2013, 58(6):334-338.
6. Wallace JL, Reaves AB, Tolley EA, et al. Comparison of initial warfarin response in obese patients versus non-obese patients. J Thromb Thrombolysis, 2013, 36(1):96-101.
7. 王斌, 徐志云, 叶小飞.华人心脏机械瓣膜置换术后华法林抗凝强度标准的系统评价.国际心血管病杂志, 2011, 37(6):361-365.
8. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-660.
9. 刘文平, 黄彩云.国产奥美拉唑治疗急性非静脉曲张性上消化道出血的Meta分析.中国循证医学杂志, 2013, 13(6):723-727.
10. 杨莉萍, 谢婧, 刘瑶, 等. CYP2C19^*2、^*3基因多态性与氯吡格雷临床疗效相关性的系统评.中国循证医学杂志, 2012, 12(9):1063-1070.
11. 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.
12. 王志伟, 徐明星, 计乐群.心脏瓣膜置换术后低强度抗凝研究.中华实验外科杂志, 2005, 22(4):484-485.
13. 王胜鹏, 王忠明.云南地区瓣膜置换术后低强度抗凝的临床研究.硕士学位论文.云南:昆明医学院, 2007.
14. 俞经生, 葛建军, 周正春.心脏瓣膜置换术后抗凝治疗的临床研究.安徽医药, 2008, 12(9):820-821.
15. 白银, 方刚.宁夏地区机械瓣膜置换术后抗凝治疗的回顾分析.宁夏回族自治区:宁夏医科大学, 2011.
16. 郝占平, 唐英杰, 丁敏, 等.机械心脏瓣膜置换术后远期抗凝状态临床观察及意义.陕西医学杂志, 2011, 40(7):827-828.
17. 徐博, 刘金城, 俞世强, 等.人工机械心脏瓣膜置换术后抗凝治疗强度与并发症发生率的关系.心脏杂志, 2012, 24(6):749-752.
18. Karl H, Gulshan KS, William GH, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4):1152-1158.
19. Sand ME, Naftel DC, Blackstone EH, et al. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg, 1987, 94(2):208-219.
20. Claiborne TE, Xenos M, Sheriff J, et al. Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation. ASAIO J, 2013, 59(3):275-283.
21. Alexander GG, Jack H, John G, et al. Randomized comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet, 1998, 331(8597):1242-1245.
22. Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease:Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl):e576S-600S.
23. Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 2011, 365(21):2002-2012.
24. Wofford JL, Wells MD, Singh S. Best strategies for patient education about anticoagulation with warfarin:a systematic review. BMC Health Serv Res, 2008, 14(8):40.
25. Baker JW, Pierce KL, Ryals CA. INR goal attainment and oral anticoagulation knowledge in an anticoagulation clinic in a Veterans Affairs medical center. J Manag Care Pharm, 2011, 17(2):133-142.
26. Garton L, Crosby JF. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis, 2011, 32(4):426-430.

Chinese Journal of Evidence-Based Medicine

Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review

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