Optimal therapeutic range for oral anticoagulants in Japanese patients with prosthetic heart valves: a preliminary report from a single institution using conversion from thrombotest to PT-INR

2000 ◽  
Vol 15 (3) ◽  
pp. 124-128 ◽  
Author(s):  
Y. Uetsuka ◽  
Saichi Hosoda ◽  
Hiroshi Kasanuki ◽  
Masahiko Aosaki ◽  
Kagari Murasaki ◽  
...  
Keyword(s):  
Therapeutic Range ◽  
Preliminary Report ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Japanese Patients ◽  
Prosthetic Heart Valves ◽  
Single Institution

scholarly journals Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

2022 ◽  
Vol 17 (6) ◽  
pp. 831-836
Author(s):  
A. S. Gerasimenko ◽  
O. V. Shatalova ◽  
V. S. Gorbatenko ◽  
V. I. Petrov
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Prosthetic Heart Valves ◽  
Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

scholarly journals Efficiency of pharmacogenetic approach to anticoagulant therapy in patients with prosthetic heart valves

Kardiologiia ◽  
2019 ◽  
Vol 59 (9S) ◽  
pp. 25-30
Author(s):  
E. V. Gorbunova ◽  
V. V. Rozhnev ◽  
A. V. Ponasenko ◽  
Olga Leonidovna Barbarash
Keyword(s):  
Anticoagulant Therapy ◽  
Therapeutic Range ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Molecular Genetic ◽  
Time Frame ◽  
Prosthetic Heart Valves ◽  
Main Diagnosis ◽  
Mechanical Prostheses ◽  
Time Required

Background. This study examined clinical, demographic, anthropometric, and inheritance factors that influence individual sensitivity to warfarin therapy after heart valve surgery. The clinical significance of the pharmacogenetic approach was assessed using the individual time frame and time spent in the INR therapeutic range. Aims. We determined the clinical outcome of the pharmacogenetic approach at the start of warfarin therapy in patients with prosthetic heart valves. Materials and methods. The study included 915 patients, of which 512 women and 403 men (mean age 56±10 years), living in Western Siberia. Rheumatic heart disease was the main diagnosis that caused the acquired defect. Mechanical prostheses were used in 70% of cases of cardiac surgery. Real-time polymerase chain reaction used for molecular genetic testing. Results. The frequencies of the alleles and genotypes of CYP2C9 and VKORC1 in the study population of patients with heart valves prosthetic correspond to the distribution in Caucasoid populations. The use of pharmacogenetic testing results at the beginning of warfarin therapy reduced the time required for selecting a therapeutic dose of anticoagulant by 2 times and increased the duration of stay in the INR therapeutic range by 20.2%. Conclusion. The use of the pharmacogenetic approach at the begin‑ ning of warfarin therapy contributes to the effectiveness and safety of anticoagulant therapy in this category of patients.

scholarly journals Murcia atrial fibrillation project II: protocol for a prospective observational study in patients with atrial fibrillation

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033712
Author(s):  
José Miguel Rivera-Caravaca ◽  
Francisco Marín ◽  
María Asunción Esteve-Pastor ◽  
Josefa Gálvez ◽  
Gregory Y.H. Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Heart Valves ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Real Life ◽  
Poor Quality ◽  
Prosthetic Heart Valves

IntroductionAtrial fibrillation (AF) is characterised by a high stroke risk. Vitamin K antagonists (VKAs) are the most commonly used oral anticoagulants (OACs) in Spain, but their efficacy and safety depend on the time in therapeutic range of International Normalized Ratio (INR) 2.0–3.0 over 65%–70%. Unfortunately, the difficulties of maintaining an optimal level of anticoagulation and the complications of VKAs (particularly haemorrhagic ones), frequently lead to cessation of this therapy, which has been associated with higher risk of adverse events (AEs), including ischaemic stroke. Our aims are as follows: (1) to evaluate the quality of oral anticoagulation with VKAs, the prevalence of poor quality of anticoagulation, and to identify factors predisposing to poor quality anticoagulation; and (2) to identify patients who will stop OAC and to investigate what factors influence the decision of OAC withdrawal.Methods and analysisProspective observational cohort study including outpatients newly diagnosed with AF and naïve for OACs from July 2016 to June 2018 in an anticoagulation clinic. Patients with prosthetic heart valves, rheumatic mitral valves or valvular AF will be excluded. Follow-up will extend for up to 3 years. During this period, the INR results and changes in the anticoagulant therapy will be recorded, as well as all AEs, or any other information that would be relevant to the proper conduct of research.Ethics and disseminationAll patients were informed about the nature and purpose of the study, and the protocol was approved by the Ethics Committee of Hospital General Universitario Morales Meseguer (reference: EST:20/16). This is an observational study focusing on ‘real life’ practice and therefore all treatments and follow-up will be performed in accordance to the routine clinical practice with no specific interventions or visits. The results of our study will be disseminated by presentations at national and international meetings, and publications in peer-reviewed journals.

Thromboembolism and Pregnancy

1999 ◽  
Vol 82 (08) ◽  
pp. 620-625 ◽  
Author(s):  
Jeffrey Ginsberg
Keyword(s):  
Pregnancy Loss ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Poor Quality ◽  
Low Molecular Weight ◽  
Prosthetic Heart Valves ◽  
Antithrombotic Agents ◽  
Low Molecular Weight Heparins ◽  
Arterial Embolism ◽  
Venous Thromboembolic

IntroductionAntithrombotic therapy during pregnancy is used for the treatment and prophylaxis of venous thromboembolic disease, for the prevention and treatment of arterial embolism associated with valvular heart disease and/or prosthetic heart valves, for the prevention of fetal growth retardation and pregnancy loss in patients with antiphospholipid antibodies, and in patients with pregnancy-induced hypertension. Since antithrombotic agents have the potential to produce complications in both the mother and fetus, their use during pregnancy raises concerns. Guidelines are difficult to establish because the evidence upon which recommendations are based is derived primarily from poor-quality studies. This chapter reviews the fetal and maternal effects of antithrombotic agents including oral anticoagulants, unfractionated heparin, low molecular weight heparins (LMWH), and aspirin, and provides recommendations for their use during pregnancy.

Subtherapeutic oral anticoagulant therapy: Frequency and risk factors

2009 ◽  
Vol 101 (03) ◽  
pp. 552-556 ◽  
Author(s):  
Eva K. Rombouts ◽  
Frits R. Rosendaal ◽  
Felix J. M. van der Meer
Keyword(s):  
Risk Factors ◽  
Anticoagulant Therapy ◽  
Therapeutic Range ◽  
Heart Valves ◽  
Hospital Admissions ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulant Drug ◽  
Nested Case Control ◽  
Control Study

SummarySubtherapeutic anticoagulation levels increase both the risk and severity of thromboembolism. The aim of this study was to determine the cumulative incidence of subtherapeutic international normalised ratios (INRs) and to identify risk factors associated with a low INR. We performed a cohort study in 7,419 patients from a Dutch anticoagulation clinic. Patients who started a first treatment with oral anticoagulants between January 2000 and December 2005 and who were stably anticoagulated (4 consecutive INRs in the therapeutic range) were included. Within the cohort a nested case control study was performed to identify risk factors of subtherapeutic INRs and to determine how often a subtherapeutic INR is the result of medical interference in case of invasive procedures, hospital admissions, haemorrhage or overanticoagulation. In patients with a stable anticoagulation, the median time to a first low INR was 40 weeks. A subtherapeutic INR occurred twice as often in patients using acenocoumarol as in those using phenprocoumon (hazard ratio [HR] 2.1, 95% confidence interval [95%CI]:2.0 – 2.3) and was more common in patients with a high therapeutic range compared to a low therapeutic range (HR 1.8, 95%CI:1.5 – 2.2). Occurrence of a low INR also depended on indication for anticoagulant therapy, with the highest risk in patients who used anticoagulants as prophylaxis and the lowest risk in patients with mechanical heart valves. In 30% of cases the subtherapeutic INR was preceded by an event necessitating vitamin K or discontinuation of the anticoagulant drug.

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