Anticoagulant Therapy in Japanese Patients With Mechanical Mitral Valves

There are no guidelines for the optimal therapeutic range of anticoagulant therapy in Japanese patients with mechanical heart valves. A total of 214 patients were followed retrospectively after mitral mechanical valve replacement (mean duration of follow-up, 4.8 years; total duration of follow-up, 1...

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Bibliographic Details
Published in:Circulation Journal 2002, Vol.66(7), pp.668-670
Main Authors: Matsuyama, Katsuhiko, Matsumoto, Masahiko, Sugita, Takaaki, Nishizawa, Junichiro, Yoshida, Kazunori, Tokuda, Yoshiyuki, Matsuo, Takehiko
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Analysis of Variance
Anticoagulant intensity
Anticoagulants - pharmacology
Anticoagulants - therapeutic use
Biological and medical sciences
Bleeding complications
Female
Heart Valve Prosthesis - adverse effects
Hemorrhage - etiology
Hemorrhage - prevention & control
Humans
Incidence
Japan
Male
Mechanical heart valves
Medical sciences
Middle Aged
Mitral Valve
Retrospective Studies
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Thromboembolism
Thromboembolism - etiology
Thromboembolism - prevention & control
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Summary:There are no guidelines for the optimal therapeutic range of anticoagulant therapy in Japanese patients with mechanical heart valves. A total of 214 patients were followed retrospectively after mitral mechanical valve replacement (mean duration of follow-up, 4.8 years; total duration of follow-up, 1,027 patient-years). The target range of the international normalized ratio (INR) for oral anticoagulation was between 1.5 and 2.5. For all patients 10,416 measurements of the INR were obtained during the follow-up period and approximately 76% of the intensity measurements were within the target range. Thromboembolism occurred in 8 patients (0.8 per 100 patient-years) and major bleeding in 5 patients (0.5 per 100 patient-years). There was no correlation between the distribution of the INR and the occurrence of thromboembolic or bleeding complications. In the univariate analysis of the various risk factors, patients who had a tilting valve or did not receive antiplatelet therapy had an increased risk of thromboembolism. However, there were no risk factors with respect to bleeding complications. A target range of 1.5 to 2.5 INR appears to be the optimal range and is safe for thromboembolism or bleeding complications. Thromboembolism may be reduced by additional antiplatelet therapy, and a tilting valve needs more intense anticoagulation. (Circ J 2002; 66: 668 - 670)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.66.668