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

2019 ◽  
Vol 20 (9) ◽  
pp. 659-667 ◽  
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.

Monitoring Warfarin Therapy with the International Normalized Ratio

1994 ◽  
Vol 28 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Patricia A. Howard
Keyword(s):  
Ct Scan ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Medical Center ◽  
Current System ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Warfarin Dosage ◽  
Local Hospital ◽  
Traditional System

OBJECTIVE: To report a case of suboptimal warfarin monitoring. CASE SUMMARY: A patient with a history of rheumatic heart disease and a mechanical mitral valve was admitted to the local hospital complaining of left-sided weakness. At the time, she was receiving warfarin 5 mg/d. Upon admission her prothrombin time (PT) was 15 s. An initial computed tomography (CT) scan of the head was negative. On the basis of the initial findings, it was unclear whether the symptoms were caused by a cerebrovascular accident (CVA). The patient was transferred to the University Medical Center for a more thorough evaluation. The diagnosis of CVA was confirmed by a repeat CT scan seven days after the event. On the basis of the information obtained from the local hospital, it was determined that the initial PT of 15 s converted to an International Normalized Ratio (INR) of 1.5, which is below the recommended range for patients with mechanical heart valves. Prior to discharge, the warfarin dosage was increased to obtain an INR in the recommended range of 2.5–3.5. DISCUSSION: This case illustrates the problems that exist with the current system of PT reporting and the potential advantages of using the INR. Variations in the sensitivity of the thromboplastin reagents used to perform the PT may result in misinterpretation of the level of anticoagulation and errors in warfarin dosage adjustments. The potential for suboptimal anticoagulation is greatly increased in patients, such as the one reported here, who are having PTs performed by multiple laboratories. CONCLUSIONS: To maximize efficacy and minimize the risk of bleeding complications, warfarin therapy must be individualized and closely monitored. Standardization of PT monitoring through the use of the INR would significantly reduce the potential for suboptimal anticoagulation associated with the traditional system of reporting.

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

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

scholarly journals Optimal target international normalized ratio for patients with mechanical heart valves

2004 ◽  
Vol 44 (5) ◽  
pp. 1142-1143 ◽  
Author(s):  
Johanna J.M. Takkenberg ◽  
John P.A. Puvimanasinghe ◽  
Lex A. van Herwerden
Keyword(s):  
Heart Valves ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Optimal Target

scholarly journals Heartbeat: Warfarin therapy for mechanical heart valves

Heart ◽  
2017 ◽  
Vol 103 (3) ◽  
pp. 175-176
Author(s):  
Catherine M Otto
Keyword(s):  
Heart Valves ◽  
Warfarin Therapy ◽  
Mechanical Heart Valves

scholarly journals In-home Compared With In-Clinic Warfarin Therapy Monitoring in Mechanical Heart Valves: A Population-Based Study

2020 ◽  
Vol 4 (5) ◽  
pp. 511-520
Author(s):  
Martin van Zyl ◽  
Waldemar E. Wysokinski ◽  
Thomas M. Jaeger ◽  
Ana I. Casanegra ◽  
Bernard J. Gersh ◽  
...  
Keyword(s):  
Heart Valves ◽  
Warfarin Therapy ◽  
Therapy Monitoring ◽  
Population Based ◽  
Mechanical Heart Valves ◽  
Population Based Study

scholarly journals Effects of Polymorphisms in Myc-Related Genes on Bleeding Complications in Patients with Stable Warfarin Responses

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Jeong Yee ◽  
Woorim Kim ◽  
Byung Chul Chang ◽  
Jee Eun Chung ◽  
Kyung Eun Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Degrees Of Freedom ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Attributable Risk ◽  
Bleeding Complications ◽  
Nucleotide Polymorphisms ◽  
Analysis Model ◽  
Clinical Value ◽  
Increased Risk

Objectives. This study aimed to identify the possible effects of Myc and 8q24 polymorphisms on bleeding complications in patients who maintained international normalized ratio (INR) of 2.0-3.0 with warfarin therapy after cardiac valve replacement. Methods. Twenty-five single nucleotide polymorphisms were analyzed, including VKORC1, CYP2C9, Myc, and 8q24. Univariate and multivariate analyses were conducted to evaluate the associations between genetic polymorphisms and bleeding complications. Attributable risk and the number needed to genotype (NNG) were also calculated to evaluate the potential clinical value of genotyping. Results. We included 142 patients, among whom 21 experienced bleeding complications. Multivariate models showed that patients carrying the CC genotype of rs6983561 and the A allele of rs13281615 at 8q24 had 27.6- and 10.0-fold higher bleeding complications, compared with patients with the A allele and the GG genotype, respectively. For rs6983561, the attributable risk and NNG were 96.4% and 36.8, respectively, whereas, for rs13281615, the attributable risk and NNG were 90.0% and 8.3, respectively. Atrial fibrillation was associated with a 5.5-fold increased risk of bleeding complications. The AUROC value was 0.761 (95% CI 0.659-0.863, p<0.001), and the Hosmer–Lemeshow test showed that the fitness of the multivariate analysis model was satisfactory (χ2=0.846; 3 degrees of freedom; p=0.838). Conclusions. Bleeding complications during warfarin therapy were associated with 8q24 polymorphisms and atrial fibrillation in patients with mechanical heart valves.

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

2009 ◽  
Vol 137 (1) ◽  
pp. 91-93 ◽  
Author(s):  
Francesco Dentali ◽  
Nicoletta Riva ◽  
Alessandra Malato ◽  
Giorgia Saccullo ◽  
Sergio Siragusa ◽  
...  
Keyword(s):  
Heart Valves ◽  
International Normalized Ratio ◽  
Mechanical Heart Valves ◽  
Thromboembolic Complications

scholarly journals Anticoagulation after Spontaneous Intraparenchymal Hemorrhage in Patients with Mechanical Heart Valves and Concomitant Atrial Fibrillation

2021 ◽  
Author(s):  
Jennifer H. Kang ◽  
Michael L. James ◽  
Allison Gibson ◽  
Ovais Inamullah ◽  
Gary Clay Sherrill ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Valves ◽  
Brain Parenchyma ◽  
Mechanical Heart Valves ◽  
Bleeding Complications ◽  
Intraparenchymal Hemorrhage ◽  
Single Institution ◽  
Discharge Disposition ◽  
Timing Of Initiation ◽  
The Brain

Abstract Aim Patients with mechanical heart valves and coexisting atrial fibrillation (AFib-MHV) who suffer an intraparenchymal hemorrhage (IPH, defined as bleeding solely within the brain parenchyma and/or ventricle) are at a high risk of thromboembolism without anticoagulation. Data are lacking regarding the safety of early re-initiation of anticoagulation in these patients. Patients and Methods We performed a descriptive, single-institution retrospective analysis of patients with AFib-MHV who suffered a non-traumatic, supratentorial IPH between July 2013 and June 2017. We analyzed the patients and IPH characteristics, anticoagulation and antiplatelet use, the occurrence of thrombotic and hemorrhage complications, and discharge disposition. We described the timing of initiation of anticoagulation and outcomes after IPH while in-patient. Results Six patients with AFib-MHV suffered a spontaneous IPH. Four were initiated on anticoagulation prior to discharge, of whom two were initiated within 3 days post-hemorrhage. These patients suffered no bleeding complications and were discharged home with a modified Rankin Scale of 1. Conclusion Patients with AFib-MHV who suffer a spontaneous IPH are a rare population to study. Further studies to guide the management of restarting anticoagulation in this select population are warranted.

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