Incidence of thromboembolic complications in patients with mechanical heart valves with a subtherapeutic international normalized ratio

Implantation of a bileaflet mechanical heart valve (BMHV) continues to be associated with a risk of thromboembolic complications despite anti-coagulation therapy1. This has been attributed to the structurally rigid design of the leaflets and valve mechanics combined with an intricate hinge mechanism for the rigid leaflets. The lack of a built in compliance within the valve mechanics presumably leads to sharp stress gradients within the flow as well as a violent closure of the valve often associated with the audible impact of the leaflets to the housing, and a potential for momentary cavitation of blood in the wake of leaflet impact.

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Major Hemorrhagic and Thromboembolic Complications in Patients with Mechanical Heart Valves Receiving Oral Anticoagulant Therapy

The Heart Surgery Forum ◽

10.1532/hsf98.20091097 ◽

2010 ◽

Vol 13 (2) ◽

pp. E80-E85

Author(s):

Przemysław Trzeciak ◽

Marian Zembala ◽

Lech Poloński

Keyword(s):

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Heart Valves ◽

Oral Anticoagulant Therapy ◽

Mechanical Heart Valves ◽

Thromboembolic Complications

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Assessment of Antithrombotic Therapy in Patients with Atrial Fibrillation for 2015-2017 According to the Registry of the Clinic of the Scientific Research Institute of Medical Problems of the North of Krasnoyarsk City

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-1-43-48 ◽

2019 ◽

Vol 15 (1) ◽

pp. 43-48

Author(s):

A. A. Tuchkov ◽

N. G. Gogolashvili ◽

R. A. Yaskevich

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Antithrombotic Therapy ◽

Heart Valves ◽

Oral Anticoagulants ◽

International Normalized Ratio ◽

Thromboembolic Complications ◽

Medical Problems ◽

The North ◽

Cardiology Department

Aim. To evaluate the volume of antithrombotic therapy (ATT) at the prehospital stage in connection with the risk of thromboembolic complications, and also to study the dynamics of the frequency of administration of oral anticoagulants (ОAC) in patients with atrial fibrillation (AF) in 2015-2017.Material and methods. The registry included 562 patients with AF at the age of 18 years and older, hospitalized in the cardiology department during 2015-2017. The registry did not include patients with AF and mechanical heart valves, mitral stenosis. The diagnosis of AF was established in accordance with the current recommendations. All patients had an assessment of the risk of thromboembolic complications on the CHA2DS2-VASc scale, the risk of bleeding on the HAS-BLED scale. The incidence of ATT at the prehospital stage was assessed depending on the risk of thromboembolic complications based on patient questioning and analysis of medical records. In addition, an assessment of the dynamics of the frequency of the OAC prescription during 2015-2017 was conducted.Results. The overwhelming majority of patients with AF (96.1%) belonged to the group of high-risk of cardioembolic strokes according to the CHA2DS2-VASc scale and had indications for OAC therapy. The frequency of OAC prescription in patients with AF who were admitted to the cardiology department was 32% at the prehospital stage, of which 19.8% of patients took warfarin and 12.2% – direct OAC. The target level of the international normalized ratio (from 2.0 to 3.0) at the time of hospitalization was observed only in 33.6% of patients taking warfarin. Over the observation period, there was a tendency to increase the frequency of OAC prescription from 30% in 2015 to 38.4% in 2017.Conclusion. Only 32% of patients with AF and high risk of thromboembolic complications received adequate antithrombotic therapy at the prehospital stage. According to the registry the frequency of OAC prescription in patients with AF during 2015-2017 increased by 8.4%. At the same time, there was a significant increase in the frequency of direct OAC prescription.

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Khat Chewing Effect on the International Normalized Ratio in Patients with Mechanical Heart Valves under Warfarin Therapy

Pakistan Journal of Biological Sciences ◽

10.3923/pjbs.2020.1487.1491 ◽

2020 ◽

Vol 23 (11) ◽

pp. 1487-1491

Author(s):

Sultan Abdulwadou ◽

Nouradden Noman Alja ◽

Abdulwahab Omer Hussa ◽

Khalid Mohammed A ◽

Suliman Gafar Sali

Keyword(s):

Heart Valves ◽

Warfarin Therapy ◽

International Normalized Ratio ◽

Mechanical Heart Valves ◽

Khat Chewing

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Low-Dose Anticoagulation in Chinese Patients with Mechanical Heart Valves

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300410 ◽

2005 ◽

Vol 13 (4) ◽

pp. 341-344 ◽

Cited By ~ 12

Author(s):

Xin-Min Zhou ◽

Wei Zhuang ◽

Jian-Guo Hu ◽

Jian-Min Li ◽

Jie-Feng Yu ◽

...

Keyword(s):

Heart Valves ◽

Low Dose ◽

Mechanical Heart Valve ◽

Major Complication ◽

International Normalized Ratio ◽

Thromboembolic Complication ◽

Mechanical Heart Valves ◽

Chinese Patients ◽

Bleeding Events

The aim of this study was to provide guidelines for optimal anticoagulation in Chinese patients after mechanical heart valve replacement. A Carbomedics valve was implanted in 178 patients between July 2000 and July 2003. During follow-up, 22 bleeding events and 1 thromboembolic complication occurred. The linearized rates of bleeding and thromboembolism were 5.83% and 0.26% per patient-year, respectively. The linearized mortality rate was 0.79% per patient-year. The final mean international normalized ratio (INR) was 1.68 ± 0.38, however there was a significant variation between the early and late periods of follow-up. For Chinese patients with mechanical heart valves, bleeding was the major complication rather than thromboembolism. Low-dose anticoagulation (international normalized ratio 1.4–2.0) could markedly decrease bleeding and effectively prevent thromboembolism. As the INR was most unstable in the first postoperative month, re-examination of patients in this period is critical.

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Association between VEGFA gene polymorphisms and bleeding complications in patients maintaining therapeutic international normalized ratio

Pharmacogenomics ◽

10.2217/pgs-2019-0005 ◽

2019 ◽

Vol 20 (9) ◽

pp. 659-667 ◽

Cited By ~ 1

Author(s):

Jeong Yee ◽

Woorim Kim ◽

Byung Chul Chang ◽

Jee Eun Chung ◽

Kyung Eun Lee ◽

...

Keyword(s):

Gene Polymorphisms ◽

Bleeding Complication ◽

Heart Valves ◽

Warfarin Therapy ◽

International Normalized Ratio ◽

Mechanical Heart Valves ◽

Bleeding Complications ◽

Wild Type ◽

Vegfa Gene

Aim: This study was designed to identify the possible effects of VEGFA polymorphisms on the occurrence of bleeding complications in patients with mechanical heart valves who have achieved therapeutic international normalized ratio (INR). Materials & methods: 13 SNPs of VEGFA were analyzed. Uni- and multi-variate analyses were conducted to identify associations between polymorphisms and bleeding complications. Results & conclusion: Patients with the CC genotype of rs35410204 had an approximately tenfold higher bleeding complication than those with the T allele. For rs866236, patients who had wild-type homozygotes showed an approximately 2.9-fold higher bleeding complication than C allele carriers. This study demonstrated that bleeding complications during warfarin therapy are associated with VEGFA polymorphisms in patients with mechanical heart valves.

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