Is high thromboembolic risk not really associated with low time in therapeutic range in patients with prosthetic heart valves?

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.

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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

Heart and Vessels ◽

10.1007/pl00007265 ◽

2000 ◽

Vol 15 (3) ◽

pp. 124-128 ◽

Cited By ~ 15

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

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

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.04.042 ◽

2018 ◽

Vol 267 ◽

pp. 68-73 ◽

Cited By ~ 9

Author(s):

Daniela Poli ◽

Emilia Antonucci ◽

Vittorio Pengo ◽

Ludovica Migliaccio ◽

Sophie Testa ◽

...

Keyword(s):

Heart Valves ◽

Prosthetic Heart Valves ◽

Thromboembolic Risk

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Urological surgery in patients with a prosthetic heart valve. Experience in 59 cases

Urologia Journal ◽

10.1177/039156039506201s14 ◽

1995 ◽

Vol 62 (1_suppl) ◽

pp. 63-65

Author(s):

A. Fandella ◽

F. Merlo ◽

L. Maccatrozzo ◽

G. Faggiano ◽

G. Anselmo

Keyword(s):

High Risk ◽

Heart Valves ◽

Oral Anticoagulants ◽

Prosthetic Heart Valve ◽

Prosthetic Heart Valves ◽

Blood Transfusions ◽

Thromboembolic Risk ◽

Intravenous Heparin ◽

Chronic Therapy ◽

Blood Clots

— Patients with prosthetic heart valves must be kept free from blood clots due to the high thromboembolic risk. Whenever these patients need to be operated, inadequate control of coagulation may lead to a high risk of haemorrhage or thrombosis. From January 1990 to December 1994, 59 patients with prosthetic heart valves undergoing chronic therapy with oral anticoagulants were treated in our Unit. Until December 1993 patients were treated with calcium heparine s.c., suspending the oral anticoagulant; this group showed a high risk of haemorrhage even with normal PTT values. In fact 19% of patients required blood transfusions while 8% had to be treated for haemorraghic complications. From January 1994 onwards, anticoagulant therapy has been changed to using intravenous heparin sodium, reducing the difficulties in monitoring and eliminating the characteristic side effects of calcium heparine s.c. therapy. There have been no haemorrhagic complications in this second group.

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The Effect of Dipyridamole and RA 233 on Human Platelet Function in Vitro

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648112 ◽

1973 ◽

Vol 29 (03) ◽

pp. 694-700 ◽

Cited By ~ 4

Author(s):

Paul L. Rifkin ◽

Marjorie B. Zucker

Keyword(s):

Mechanism Of Action ◽

Human Blood ◽

Glass Bead ◽

Heart Valves ◽

Human Platelet ◽

Drug Effects ◽

Simple Relation ◽

Prosthetic Heart Valves ◽

Induced Aggregation

SummaryDipyridamole (Persantin) is reported to prolong platelet survival and inhibit embolism in patients with prosthetic heart valves, but its mechanism of action is unknown. Fifty jxM dipyridamole failed to reduce the high percentage of platelets retained when heparinized human blood was passed through a glass bead column, but prolonged the inhibition of retention caused by disturbing blood in vitro. Possibly the prostheses act like disturbance. Although RA 233 was as effective as dipyridamole in inhibiting the return of retention, it was less effective in preventing the uptake of adenosine into erythrocytes, and more active in inhibiting ADP-induced aggregation and release. Thus there is no simple relation between these drug effects.

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Faculty of 1000 evaluation for Antiplatelet and anticoagulation for patients with prosthetic heart valves.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718029022.793482087 ◽

2013 ◽

Author(s):

David Varon

Keyword(s):

Heart Valves ◽

Prosthetic Heart Valves

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Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.06.10827 ◽

2020 ◽

Vol 103 (6) ◽

pp. 548-552

Keyword(s):

Atrial Fibrillation ◽

Therapeutic Range ◽

Statistical Significance ◽

Discrimination Performance ◽

Poor Quality ◽

Chi Square ◽

Exact Test ◽

Time In Therapeutic Range ◽

Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

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