Better anticoagulation control improves survival after valve replacement

Butchart, Eric G.; Payne, Nicola; Li, Huihua; Buchan, Keith; Mandana, Kayapanda; Grunkemeier, Gary L.

doi:10.1067/mtc.2002.121162

Cited by 130 publications

(80 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, due to the lower and slower flows across the atrioventricular valves, it is established practice to anti-coagulate mechanical mitral and tricuspid valves to a greater degree than aortic and pulmonic valves. Data support this practice (Butchart et al, 2002;Ezekowitz, 2002). This requirement of anticoagulation is the primary disadvantage of mechanical valve prostheses, as they are more durable than allograft or xenograft prostheses.…”

Section: Valvular Thrombosismentioning

confidence: 72%

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Mohan

Rajagopal

2003

Computational and Mathematical Methods in Medicine

140

121

View full text Add to dashboard Cite

Multiple interacting mechanisms control the formation and dissolution of clots to maintain blood in a state of delicate balance. In addition to a myriad of biochemical reactions, rheological factors also play a crucial role in modulating the response of blood to external stimuli. To date, a comprehensive model for clot formation and dissolution, that takes into account the biochemical, medical and rheological factors, has not been put into place, the existing models emphasizing either one or the other of the factors. In this paper, after discussing the various biochemical, physiologic and rheological factors at some length, we develop a model for clot formation and dissolution that incorporates many of the relevant crucial factors that have a bearing on the problem. The model, though just a first step towards understanding a complex phenomenon, goes further than previous models in integrating the biochemical, physiologic and rheological factors that come into play.

show abstract

Section: Valvular Thrombosismentioning

confidence: 72%

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Mohan

Rajagopal

2003

Computational and Mathematical Methods in Medicine

140

121

View full text Add to dashboard Cite

show abstract

“…2,13,22,23 Lower INRs may decrease bleeding, 10,16,17,19,34 while unstable anticoagulation predicts valve-related events. 33,35,36 In the present study, INR variability (ie, INR SD) tended to univariately predict TE risk and independently predict bleeding. 35,36 Thus, reducing INR variability is a stronger objective than INR level after MVR.…”

Section: Anticoagulation Effectmentioning

confidence: 83%

“…Our population-based study allowed complete collection of INRs with higher documentation than most attentive observational studies 14,33 and comparable to prospective clinical trials. 3,10,21 Moreover, anticoagulation is analyzed not as intention to treat but as achieved INRs.…”

Section: Anticoagulation Effectmentioning

confidence: 99%

“…Because high-intensity anticoagulation is associated with high variability, lower INR goals (possibly 2 to 3) would reduce variability. Also, higher testing frequency improves the length of time spent in the target range 33,[37][38][39] and is an incentive for anticoagulation clinics or INR selfmanagement 21,27,38 as tools to improve anticoagulation effectiveness.…”

Section: Anticoagulation Effectmentioning

confidence: 99%

See 1 more Smart Citation

Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

Tourneau

Lim

Inamo

et al. 2009

Chest

View full text Add to dashboard Cite

Background: Thromboembolic events (TEs) are frequent after mechanical mitral valve replacement (MVR), but their association to anticoagulation quality is unclear and has never been studied in a population-based setting with patients who have a complete anticoagulation record. Conclusion: This population-based comprehensive study of anticoagulation and TE post-MVR shows that, in these closely anticoagulated patients, anticoagulation intensity was highly variable and not associated with TE incidence post-MVR. Higher anticoagulation intensity is linked to higher variability and, thus, to bleeding. The MVR-ball prosthesis design is associated with higher TE rates notwithstanding higher anticoagulation intensity, and its use should be retired worldwide.(CHEST 2009; 136:1503-1513)

show abstract

“…Butchart et al [29] followed a cohort study where they collected 82,297 blood samples for obtaining the international normalized ratio (INR) of 1,476 patients who underwent surgery for valve replacement by mechanical prostheses between 1979 and 1994 and were followed up until 1998, noting that the high anticoagulation variability is the most important independent predictor of survival. The variability of anticoagulation was expressed for each patient, the percentage of INR values †outside the limits between 2.0 and 4.0.…”

Section: Fig 3 -Kaplan-meier Time To Assess Event-free Bleedingmentioning

confidence: 99%

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas

Almeida

Picon

Wender

2011

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicasOutcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prosthesesThis study was carried out at Clinics Hospital of Porto Alegre, Porto Alegre, RS, Brazil. AbstractObjective: This paper evaluates outcomes in patients subjected to surgery for replacement of the aortic valve using biological or mechanical substitutes, where selection of the type of prosthesis is relevant.Methods: Three hundred and one patients, randomly selected, who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years.Results: Survival at 5, 10 and 15 years after surgery using mechanical substitute was 83.9%, 75.4% and 60.2% and, for biological substitute, was 89.3%, 70.4% and 58.4%, respectively (P=0.939). Factors associated with death were: age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. Probability free of reoperation for these patients at 5, 10 and 15 years after surgery using mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (P=0.057). Factors associated with reoperation were: renal failure, prosthesis endocarditis and age. Probability free of bleeding events at 5, 10 and 15 years after surgery using mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (P=0.047). Factors associated with bleeding events were: renal failure and mechanical prostheses.Conclusions: The authors have concluded that: 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using mechanical prosthesis had more bleeding events as time passed; 5) data presented in this paper is in accordance with current literature. Descriptors 327Almeida AS, et al. -Outcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prostheses Bras Cir Cardiovasc 2011;26(3):326-37 Rev

show abstract

Better anticoagulation control improves survival after valve replacement

Abstract: High anticoagulation variability is the most important independent predictor of reduced survival after valve replacement with a mechanical valve. Better anticoagulation control should improve survival.

Cited by 130 publications

References 34 publications

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

A Model Incorporating Some of the Mechanical and Biochemical Factors Underlying Clot Formation and Dissolution in Flowing Blood

Achieved Anticoagulation vs Prosthesis Selection for Mitral Mechanical Valve Replacement

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas

Contact Info

Product

Resources

About