Mechanical prosthetic heart valves: Quality of anticoagulation and thromboembolic risk. The observational multicenter PLECTRUM study

Autor: Poli, D., Antonucci, E., Pengo, V., Migliaccio, L., Testa, S., Lodigiani, C., Coffetti, N., Facchinetti, R., Serricchio, G., Falco, P., Mangione, C., Masottini, S., Ruocco, L., De Caterina, R., Palareti, G., Italian Federation of Anticoagulation Clinics
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
medicine.drug_class
Hemorrhage
030204 cardiovascular system & hematology
Mechanical heart valves
03 medical and health sciences
Anticoagulation
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
Thromboembolism
Outcome Assessment
Health Care
medicine
Humans
In patient
Bleeding
Stroke
Vitamin K antagonists
030212 general & internal medicine
International Normalized Ratio
Blood Coagulation
Prosthetic heart
Aged
Retrospective Studies
Heart Valve Prosthesis Implantation
business.industry
Anticoagulants
Atrial fibrillation
Retrospective cohort study
Vitamin K antagonist
Middle Aged
medicine.disease
Thromboembolic risk
Italy
Heart Valve Prosthesis
Cardiology
Observational study
Female
Warfarin
Drug Monitoring
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Popis: Patients with a mechanical prosthetic heart valve implantation need to be treated with a vitamin K antagonist (VKA) due to a substantially high risk of thromboembolism. In this study we report data on patients with mechanical heart valves (MV), with the aim of evaluating the thromboembolic risk in relation to the type and site of implantation, quality of anticoagulation and risk factors associated with thromboembolism.Observational retrospective multicenter study among Centers affiliated to the Italian Federation of Anticoagulation Clinics (FCSA) on patients with MV implanted after 1990 and followed for the management of anticoagulation.We analyzed 2357 patients with mechanical heart valves (55.2% males), followed for 24,081 years. During the follow-up, 164 thromboembolic events (0.67/100 pt-yrs) and 243 major bleedings (1.0/100 pt-yrs) occurred. The median Time in Therapeutic Range (TTR), calculated in all intended INR classes, was 60% (IQR 47-74%). The rates of thrombotic events were significantly higher in patients intended to stay at therapeutic rangesINR 2.0-3.0. The presence of atrial fibrillation, history of thromboembolism and of mitral prosthesis were independently associated with thromboembolism. However, a bad quality of anticoagulation (TTR47%, 25°percentile of our population) was not correlated with thromboembolism.A low rate of bleeding and thromboembolic events in patients with mechanical heart valves were found, despite the sub-optimal anticoagulation control. The thromboembolic risk was not associated with the low TTR.
Databáze: OpenAIRE
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