Outcomes of Patients with a Mechanical Heart Valve and Poor Anticoagulation Control on Warfarin.

Autor:	Johansson I; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada.; Division of Cardiology, Department of Medicine K2, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden., Benz AP; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada.; Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany., Kovalova T; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada., Balasubramanian K; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada., Fukakusa B; Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada., Lynn MJ; Department of Medicine, University of British Columbia, Vancouver, Canada., Nair N; Division of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada., Sikder O; Division of Medicine, School of Nursing, McMaster University, Hamilton, Canada., Patel K; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Gayathri S; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada., Robinson M; Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada., Hardy C; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada., Tyrwhitt J; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada., Schulman S; Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada., Eikelboom JW; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada., Connolly SJ; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Thrombosis and haemostasis [Thromb Haemost] 2024 Jul; Vol. 124 (7), pp. 613-624. Date of Electronic Publication: 2023 Dec 29.
DOI:	10.1055/s-0043-1777827
Abstrakt:	Background:  Patients with a mechanical heart valve (MHV) require oral anticoagulation. Poor anticoagulation control is thought to be associated with adverse outcomes, but data are limited. Objective:  To assess the risks of clinical outcomes in patients with a MHV and poor anticoagulation control on warfarin. Methods:  We conducted a retrospective study of consecutive patients undergoing MHV implantation at a tertiary care center (2010-2019). Primary outcome was a composite of ischemic stroke, systemic embolism, or prosthetic valve thrombosis. Major bleeding and death were key secondary outcomes. We constructed multivariable regression models to assess the association between time in therapeutic range (TTR) on warfarin beyond 90 days after surgery with outcomes. Results:  We included 671 patients with a MHV (80.6% in aortic, 14.6% in mitral position; mean age 61 years, 30.3% female). Median follow-up was 4.9 years, mean TTR was 62.5% (14.5% TTR <40%, 24.6% TTR 40-60%, and 61.0% TTR >60%). Overall rates of the primary outcome, major bleeding, and death were 0.73, 1.41, and 1.44 per 100 patient-years. Corresponding rates for patients with TTR <40% were 1.31, 2.77, and 3.22 per 100 patient-years. In adjusted analyses, every 10% decrement in TTR was associated with a 31% increase in hazard for the primary outcome (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.13-1.52), 34% increase in major bleeding (HR: 1.34, 95% CI: 1.17-1.52), and 32% increase in death (HR: 1.32, 95% CI: 1.11-1.57). Conclusion:  In contemporary patients with a MHV, poor anticoagulation control on warfarin was associated with increased risks of thrombotic events, bleeding, and death. Competing Interests: I.J. has received consultancy fees from AstraZeneca, Novo Nordisk, and Boehringer Ingelheim and is supported by unrestricted research grants from Stockholm County Council, Swedish Heart-Lung Foundation, AstraZeneca, and Swedish Society of Cardiology. J.W.E. has received honoraria and/or research support from Anthos, AZ, Bayer, BI, BMS, DSI, Idorsia, Janssen, Merck, and Pfizer. M.R. has received honoraria support in the past from Bayer, BI, and Pfizer. S.S. has received research funding from Octapharma and honoraria from Alexion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Pfizer, and Sanofi. S.J.C. has received honoraria or research grants from Bayer, BMS, Pfizer, AstraZeneca, Javelin, Daiichi Sankyo. The remaining authors have no conflicting interests to report. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu