Low-Dose Anticoagulation in Chinese Patients with Mechanical Heart Valves

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.

Download Full-text

Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

European Heart Journal ◽

10.1093/eurheartj/ehab724.0681 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

G Loughlin ◽

M Pachon ◽

J.L Martinez-Sande ◽

J.L Ibanez ◽

T Bastante ◽

...

Keyword(s):

Heart Valves ◽

Pacemaker Implantation ◽

Major Complication ◽

Mechanical Heart Valves ◽

Electrical Performance ◽

Funding Sources ◽

Leadless Pacemaker ◽

Attractive Option ◽

Procedural Outcomes

Abstract Introduction Device-related infections constitute a major complication of transvenous pacemaker implantation. Mechanical heart valves (MHV) increase the risk of infective endocarditis (IE) and pacemaker infection, worsening their outcomes.Leadless pacemakers (LP) have been associated with low infection rates and thus pose an attractive option in MHV patients requiring permanent pacing. Methods and results This is a multicenter, observational, retrospective study including all consecutive patients implanted with an LP at 5 tertiary referral centers between June 2015 and January 2020.Procedural outcomes, complications, performance during follow-up and episodes of bacteremia and IE were recorded and compared between patients with and without a MHV (MHV and non-MHV groups).Four hundred fifty-nine patients were included (74 in the MHV group, 16.1%, and 385 in the non-MHV group, 83.9%).Implantation success, procedural outcomes and acute electrical performance were comparable between groups.Vascular complications and cardiac perforation occurred in 2.7 vs. 2.3% (p=1) and 0% vs. 0.8% (p=1) in the MHV group and non-MHV group, respectively.During a median post-implant follow-up of 308 days for the MHV group and 416 days for non-MHV patients (p=0.029), one case of IE was reported in the MHV group and 2 in the non-MHV group. All three occurred in patients with abandoned transvenous leads. Conclusion LP implantation is feasible and safe in patients with MHV, with procedural outcomes and electrical performance comparable to the general LP population. Device-related infections, including IE, are rare in patients receiving an LP, including those with an MHV. LP implantation should be considered in MHV patients with an indication for pacing. Funding Acknowledgement Type of funding sources: None. Procedural outcomes and complicationsBaseline and follow-up parameters

Download Full-text

Evaluation of Extended-Interval Dabigatran Dosing in Older Patients With Non-Valvular Atrial Fibrillation

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248420977223 ◽

2020 ◽

pp. 107424842097722

Author(s):

Lianfang Ni ◽

Xiahuan Chen ◽

Meilin Liu ◽

Yan Fan ◽

Zhifang Fu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Creatinine Clearance ◽

Partial Thromboplastin Time ◽

Older Patients ◽

Low Dose ◽

Activated Partial Thromboplastin Time ◽

Chinese Patients ◽

Bleeding Events ◽

Dosing Intervals

Objective: To evaluate the safety and efficacy of extended-interval dabigatran dosing in older Chinese patients with non-valvular atrial fibrillation. Methods: We conducted an observational study on non-valvular atrial fibrillation patients administered dabigatran at different dosing intervals at the Department of Geriatrics, Peking University First Hospital, China. We enrolled 121 consecutive non-valvular atrial fibrillation patients aged ≥60 years on dabigatran therapy (mean age, 79.6 ± 7.4 years); they were administered conventional low-dose dabigatran (110 mg twice daily) or extended-interval dosing with dabigatran (110 mg every 16 h or every 24 h). All patients received follow-up care, and we evaluated the presence of bleeding and thromboembolic events. Results: All patients exhibited creatinine clearance greater than 30 mL/min with an average of 56.6 ± 17.3 mL/min. Sixty-two patients received extended-interval dosing with dabigatran at a mean dose of 117.1 ± 18.6 mg daily. Patients on extended-interval dosing were older; they exhibited lower creatinine clearance and bodyweight and higher CHA2DS2-VASc and HAS-BLED scores. The mean follow-up time was 25.8 ± 15.6 months. No significant differences were observed in the trough and peak values of the activated partial thromboplastin time and in thromboembolic or bleeding events between the 2 groups. Conclusion: Extended-interval dabigatran dosing in older patients with non-valvular atrial fibrillation and lower creatinine clearance can maintain activated partial thromboplastin time trough and peak values comparable to the conventional low dose. Physician-prescribed practices regarding dabigatran dosing intervals do not lead to worse outcomes in the above-mentioned population.

Download Full-text

Abstract 17101: Low-intensity Anticoagulant Treatment in Chinese Patients with Mechanical Heart Valve Prostheses: Early Outcomes of a Prospective, Multicenter Registry in China

Circulation ◽

10.1161/circ.130.suppl_2.17101 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

JIA HU ◽

BO FU ◽

Jian-ping Xu ◽

Ying-kang Shi ◽

Li Dong

Keyword(s):

Valve Replacement ◽

Heart Valve ◽

Heart Valves ◽

Anticoagulation Therapy ◽

Mechanical Heart Valve ◽

Heart Valve Replacement ◽

Chinese Patients ◽

Anticoagulant Treatment ◽

Low Intensity

Background: Current guidelines recommend vitamin K antagonist treatment with relatively higher international normalized ratio (INR) targets for patients with mechanical heart valve prostheses. However, there is lack of data from large clinical trials about the outcomes of low-intensity anticoagulant treatment in Chinese patients with mechanical heart valves. Methods: The Low-intensity Anticoagulation Therapy after Heart Valve Replacement is an ongoing multicenter, prospective, observational cohort study (ChiCTR-OCH-10001185). Between January 2011 and August 2013, qualified patients from 34 cardiac centers in China mainland were recruited in the Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement. Baseline characteristics were collected and patients were followed up for anticoagulant treatment, INRs and adverse events till March 2014. Results: The database recruited 11,769 patients, and 11,040 patients (93.8%) undergoing mechanical heart valve replacement were analyzed in this study. The mean age was 48.9±11.5 years and 6,227 patients (56.4%) were female. A total of 9,870 patients (89.4%) of the baseline population completed at least 6 months follow-up. The median follow-up time was 1.2 years (range 0.5-2.2). For all 9,870 patients, 143,115 measurements of the INR were obtained. The average warfarin dosage was 2.98±1.16mg/d and the mean INR was 1.81±0.46, and 88.7% patients had an INR level≤2.5 during the follow-up period. The incidence of hemorrhagic events was the lowest in patients with an INR≤2.0, whereas the risk of thromboembolic complications in this group of patients was not significantly increased (Table 1). Conclusions: Low-intensity anticoagulation with an INR of 1.5 to 2.5 is safe and effective for Chinese patients with mechanical heart valves in short-term. The optimal INR targets for mechanical valve recipients with different implanting positions and risk factors require further investigation.

Download Full-text

Argatroban and bivalirudin compared to unfractionated heparin in preventing thrombus formation on mechanical heart valves

Thrombosis and Haemostasis ◽

10.1160/th08-09-0571 ◽

2009 ◽

Vol 101 (06) ◽

pp. 1163-1169 ◽

Cited By ~ 10

Author(s):

Torsten Linde ◽

Thomas Michel ◽

Kathrin Hamilton ◽

Ulrich Steinseifer ◽

Ivar Friedrich ◽

...

Keyword(s):

Electron Microscopy ◽

Unfractionated Heparin ◽

Continuous Infusion ◽

Valve Replacement ◽

Heart Valves ◽

Thrombus Formation ◽

Mechanical Heart Valve ◽

Mechanical Heart Valves ◽

Valve Prostheses

SummaryPrevention of valve thrombosis in patients after prosthetic mechanical heart valve replacement and heparin-induced thrombocytopenia (HIT) is still an open issue. The aim of the present in-vitro study was to investigate the efficacy of argatroban and bivalirudin in comparison to unfractionated heparin (UFH) in preventing thrombus formation on mechanical heart valves. Blood (230 ml) from healthy young male volunteers was anticoagulated either by UFH, argatroban bolus, argatroban bolus plus continuous infusion, bivalirudin bolus, or bivalirudin bolus plus continuous infusion. Valve prostheses were placed in a newly developed in-vitro thrombosis tester and exposed to the anticoagulated blood samples. To quantify the thrombi, electron microscopy was performed, and each valve was weighed before and after the experiment. Mean thrombus weight in group 1 (UFH) was 117 + 93 mg, in group 2 (argatroban bolus) 722 + 428 mg, in group 3 (bivalirudin bolus) 758 + 323 mg, in group 4 (argatroban bolus plus continuous infusion) 162 + 98 mg, and in group 5 (bivalirudin bolus plus continuous infusion) 166 + 141 mg (p-value <0.001). Electron microscopy showed increased rates of thrombus formation in groups 2 and 3. Argatroban and bivalirudin were as effective as UFH in preventing thrombus formation on valve prostheses in our in-vitro investigation when they were administered continuously. We hypothesise that continuous infusion of argatroban or bivalirudin are optimal treatment options for patients with HIT after mechanical heart valve replacement for adapting oral to parenteral anticoagulation or vice versa.

Download Full-text