D-Dimer to Predict the Clinical Outcomes in Patients with Mechanical Heart Valve Replacement During Oral Anticoagulation Therapy
Autor: | Hongyan Xiao, Yanli Long, Zhenlu Zhang, Litao Zhang, Xiaohui Liu, Jun Yang |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Administration Oral 030204 cardiovascular system & hematology Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine Mechanical heart valve replacement Internal medicine D-dimer medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Adverse effect Heart Valve Prosthesis Implantation business.industry Incidence (epidemiology) Hazard ratio Anticoagulants General Medicine Middle Aged medicine.disease Thrombosis Confidence interval Treatment Outcome Cardiology Female Warfarin Cardiology and Cardiovascular Medicine business |
Zdroj: | International heart journal. 60(3) |
ISSN: | 1349-3299 0199-6657 |
Popis: | Mechanical heart valve replacement (MHVR) entails lifetime oral anticoagulation to eliminate thrombosis. However, adverse events may still occur despite proper anticoagulation therapy. In this study, we investigated whether D-dimer can predict the clinical events in post-MHVR patients during oral anticoagulation therapy.This was a single-center, prospective study. In all, 772 patients who underwent MHVR in the Wuhan Asia Heart Hospital from January 2013 to May 2014 were screened. Patients were assigned to the abnormal D-dimer group and the normal D-dimer group according to the D-dimer levels measured 3 months after the beginning of the oral anticoagulation therapy regime. All patients were followed up for 24 months or until the observation of the endpoints, which included thrombotic events, bleeding events, and all-cause deaths.A total of 718 patients were included in the analysis: 91 had abnormal D-dimer levels, and 627 had normal D-dimer levels. In all, 53 events were observed during 24 months. Compared with the normal D-dimer group, patients with abnormal D-dimer levels had a higher incidence of thrombotic events (10 versus 14; hazard ratio (HR): 5.36; 95% confidence interval (CI): 2.38-12.1; P < 0.001), all-cause mortality (8 versus 13; HR: 4.65; 95% CI: 1.93-11.2; P < 0.001), and a higher incidence of total events (16 versus 37; HR: 3.26; 95% CI: 1.81-5.86; P < 0.001). No significant difference was observed in bleeding events (2 versus 21; HR: 0.72; 95% CI: 0.17-3.07; P = 0.66).D-dimer may be a useful marker to predict thrombotic events and all-cause deaths in post-MHVR patients during oral anticoagulation therapy (ClinicalTrials.gov; NCT01996657). |
Databáze: | OpenAIRE |
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