INR Control of Patients with Mechanical Heart Valve on Long-Term Warfarin Therapy

Tan, Clare; Fong, Alan Yean Yip; Jong, Yuan Hsun; Ong, Tiong Kiam

doi:10.1016/j.gheart.2018.08.003

Cited by 13 publications

(13 citation statements)

References 18 publications

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“…A prior retrospective study demonstrated a mean TTR of 72.5% in Swedish patients with mechanical heart valve prosthesis; another study showed that the mean TTR was 47.48% in Malaysian patients with mechanical heart valve(s) replacement. 26,27 The mean TTR in patients with PHV in this study was 30.5%, which was lower than the previously reported rate. Our study also demonstrated that warfarin control was worse in patients with PHV than in patients with AF.…”

Section: Status Of Warfarin Control In Hong Kongcontrasting

confidence: 77%

Warfarin control in Hong Kong clinical practice: a single-centre observational study

et al. 2020

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Time in therapeutic range (TTR) assesses the safety and effectiveness of warfarin therapy using the international normalised ratio. This study investigated the TTR in Hong Kong patients using both European and Japanese therapeutic ranges and patients' economic and clinical outcomes. Predictors of poor warfarin control and patient knowledge concerning warfarin therapy were assessed. Methods:A 5-month observational study with retrospective and prospective components was conducted in the Prince of Wales Hospital. The study examined electronic patient records of patients who received warfarin for at least 1 year during the period from January 2010 to August 2015. Patient knowledge was assessed via phone interview using the Oral Anticoagulation Knowledge (OAK) test.Results: In total, 259 patients were included; 174 completed the OAK test. The calculated mean TTR was 40.2±17.1% (European therapeutic range), compared with 49.1±16.1% (Japanese therapeutic range) [P<0.001]. Mean TTR was higher in patients with atrial fibrillation than in patients with prosthetic heart valve (P<0.001). The abilities of TTR to predict clinical and economic outcomes were comparable between European and Japanese therapeutic ranges. Patients with ideal TTR had fewer clinical

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Section: Status Of Warfarin Control In Hong Kongcontrasting

confidence: 77%

Warfarin control in Hong Kong clinical practice: a single-centre observational study

et al. 2020

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“…A 5-year retrospective cohort study from Swedish registries reported a mean TTR of 72.5% in patients with mechanical heart valve prosthesis, while another study in Malaysia showed that mean TTR in patients with mechanical heart valve(s) replacement was 47.48%. 34,35 Mean TTR in patients with PHV in this study was 30.5%, lower than the previously reported findings. Our study also demonstrated that warfarin control in patients with PHV was worse that patients with AF.…”

Section: Status Of Warfarin Control In Hong Kongcontrasting

confidence: 80%

“…. Out of 259 patients,35.9% of subjects experienced complications including thrombotic events and bleeding complications.Out of the 39 patients with thrombotic events, 41.0% of them had recurrent non-ST elevation myocardial infarction and 33.3% had stroke. For bleeding complications, 68.8% had minor bleeding while 31.3% of them experienced major bleeding episodes.…”

mentioning

confidence: 99%

Warfarin control in Hong Kong clinical practice

Lam

Lee

Mak

et al. 2019

Preprint

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Objectives: Time-in-therapeutic range (TTR) assesses safety and effectiveness of warfarin therapy using international normalized ratio (INR). This study aimed to investigate the status of TTR in Hong Kong and patients’ economic and clinical outcomes. Predictors of poor warfarin control and patient’s knowledge in warfarin therapy were assessed. Methods: A five-month observational study was conducted in Prince of Wales Hospital in Hong Kong. The TTRs calculated using Caucasian and Japanese therapeutic range were examined among patients on warfarin for at least one year. Patients’ knowledge was assessed using the Oral Anticoagulation Knowledge (OAK) test. Results: A total of 259 patients were included in this study, with 174 of them completed the OAK test. Using Caucasian therapeutic range, calculated mean TTR was 40.2 ± 17.1%, compared that of 49.1 ± 16.1% with Japanese therapeutic range (P<0.001). Mean TTR in patients with atrial fibrillation was higher than those with prosthetic heart valve (p<0.001). Predictability of TTR on clinical outcomes and economic outcomes was comparable between Caucasian and Japanese therapeutic range. Patients with ideal TTR had fewer clinical complications and lower warfarin-related healthcare costs. Patients with younger age, concurrent use of aspirin, frusemide, famotidine, pantoprazole and simvastatin were associated with poorer TTR. Mean score of OAK test was 54.1%. Only 24 patients (13.8%) achieved the satisfactory overall score of ≥75% in the test. Conclusion: Warfarin use in Hong Kong patients was poorly controlled regardless of indication. Patients’ knowledge towards warfarin use was suboptimal. More education to patients on warfarin use is warranted.

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“…Among patients with atrial fibrillation, studies have shown an association between low quality of VKA treatment and the risk of outcomes, whereas studies on patients with mechanical heart valve have shown contradictory results. [8][9][10][11] This nationwide, carefully designed study set out to examine the association between TTR and the risk of thromboembolic events and bleeding in patients with mechanical valve prostheses.…”

Section: Perspectivementioning

confidence: 99%

“…Results: In total, 659 patients undergoing mechanical heart valve replacement were included in the study. Median number of international normalized ratio measurements in the 6-month period after surgery was 13 (interquartile range, [8][9][10][11][12][13][14][15][16][17][18][19]. Median TTR was 54.9% (interquartile range, 39.0%-72.9%) and 29.1% of patients had a TTR !70%.…”

mentioning

confidence: 99%

Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis

Havers-Borgersen

Butt

Vinding

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Oral anticoagulation with vitamin K antagonists is recommended after mechanical heart valve replacement. However, data regarding the association between the quality of vitamin K antagonist treatment and the risk of complications are sparse.Methods: Patients undergoing mechanical heart valve replacement (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) with available data on international normalized ratio values were identified in Danish registries. The quality of vitamin K antagonist treatment between discharge after valve replacement and 6 months postdischarge (ie, index) was assessed as time in therapeutic range (TTR) !70% or<70% reflecting the percentage of time in therapeutic international normalized ratio interval. Patients were followed from index until occurrence of an outcome of interest (ie, thromboembolism and bleeding), death, or end of study (December 31, 2012), whichever came first. The risk of outcomes according to quality of vitamin K antagonist treatment was estimated with multivariable Cox regression.See Commentaries on pages 84 and 86.More than 100 million people worldwide experience valve diseases and the prevalence is expected to increase concurrently with increasing life expectancy. 1 Worldwide, From the

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INR Control of Patients with Mechanical Heart Valve on Long-Term Warfarin Therapy

Abstract: Despite a majority of patients having <60% TTR, there were low incidences of bleeding and stroke events in this center. There were no factors found to be associated with INR control in this study.

Cited by 13 publications

References 18 publications

Warfarin control in Hong Kong clinical practice: a single-centre observational study

Warfarin control in Hong Kong clinical practice: a single-centre observational study

Warfarin control in Hong Kong clinical practice

Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis

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