International normalized ratio for the guidance of warfarin treatment in elderly patients after cardiac valve replacement

Ma, Qiang; Fang, Jian‑Hai

doi:10.3892/etm.2018.7078

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…In China, cardiac valve replacements account for 30% of cardiac procedures. 4 With the continuous improvements in perioperative management and surgical techniques, heart valve surgery has lower mortality. However, there is a high incidence of thrombo-embolic events of approximately 1–4% per year.…”

Section: Discussionmentioning

confidence: 99%

Mechanical valve replacement without anticoagulation: a case report

Wang

Lin

et al. 2021

European Heart Journal - Case Reports

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Background For patients who undergo mechanical valve replacement, the greatest disadvantage is that they require long-term or permanent use of anticoagulant therapy to prevent thromboembolism. To date, mechanical valve replacement without anticoagulation has been published in the literature. Case summary We present the case of a 75-year-old female who underwent mechanical mitral valve replacement (MVR) on mid-June, 2007. However, this patient had not been taking anticoagulant medication since she experienced warfarin overdose in the first month after the operation. She had been well without using any anticoagulation, and there were no complications of the mechanical valve. Discussion There was no thrombosis for such a long period of time because she suffered from FX deficiency. To the best of our knowledge, she may be the only patient who has been well without any anticoagulation since not taking warfarin 12 years ago.

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Section: Discussionmentioning

confidence: 99%

Mechanical valve replacement without anticoagulation: a case report

Wang

Lin

et al. 2021

European Heart Journal - Case Reports

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“…However, inter‐device variations in the PT make it difficult to compare among different institutions 29 . The international normalized ratio (INR) refers to the ratio of prothrombin time to the normal prothrombin time 30 and is regarded as an ideal method for judging the anticoagulation effect 31 . It overcomes the variability among different laboratories by thromboplastin sensitivity 32 .…”

Section: Introductionmentioning

confidence: 99%

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Peng

Zeng

et al. 2021

Orthopaedic Surgery

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Objective: To verify whether an elevated preoperative international normalized ratio (INR) increases transfusion and complications independently in primary total hip arthroplasty (THA) with the management of an enhanced recovery after surgery (EARS) protocol. Methods:We retrospectively reviewed the database of adults who underwent primary THA between 2014 and 2018 by the same surgeon. A total of 552 patients were assigned into three groups by preoperative INR class: INR ≤ 0.9, 0.9 < INR < 1.0, and INR ≥ 1.0. We regarded transfusion within 90 days during the same hospitalization as the primary outcome. We also included perioperative blood loss, maximum Hb drop, postoperative anaemia requiring medicine, and length of hospital stay (LOS) during the same hospitalization in the study. Complications and reoperation at 90 days and mortality at 90 days and 12 months were also included in the study. Univariable analyses were utilized to compare baselines and outcomes among the three groups. Multivariate logistic regressions were used to adjust for differences at baseline among the groups.Results: All patients had an INR < 1.5 preoperatively and were managed with the ERAS protocol. Among them, 93 (16.8%) patients had INR ≤ 0.9, 268 (48.6%) patients had 0.9 < INR < 1.0, and 191 (34.6%) patients had INR ≥ 1.0. In the univariable analyses, as the INR increased, the transfusion rates increased from 1.08% for INR ≤ 0.9, to 1.12% for 0.9 < INR < 1.0 and to 5.76% for INR ≥ 1.0 (P < 0.05). The overall complication rate increased from 10.8% for INR ≤ 0.9, to 16.4% for 0.9 < INR < 1.0, and to 22.5% for INR ≥ 1.0 (P < 0.05). The length of stay (LOS) in the INR ≥ 1.0 group was 5.7 AE 2.2 days, which was significantly longer than that in the INR ≤ 0.9 group (4.7 AE 1.6 days, P = 0.000) and 0.9 < INR < 1.0 group (5.1 AE 2.0 days, P = 0.007). No statistical significance was detected among the groups regarding blood loss, maximum Hb drop, or the incidence of postoperative anaemia that required medicine. There was no significant difference in reoperation or mortality among the groups. When controlling for demographic and comorbidity characteristics, there was no statistically significant difference in the odds of transfusion during the same hospitalization or overall complications at 90 days among the groups (P > 0.05). Conclusions: Elevated preoperative INR cannot increase transfusion or complication rates independently in primaryTHA with the management of the ERAS protocol. With the improvement in the ERAS protocol and the use of tranexamic acid (TXA), an INR < 1.5 is still a conventional safe threshold for THA surgery.

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“…INR refers to the ratio of prothrombin time to the normal prothrombin time [7] which were regarded as an ideal method for judging the anticoagulation effect [8]. It can overcome variability between different laboratories by thromboplastin sensitivity [9].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

Peng¹,

Zeng²,

Zeng³

et al. 2020

Preprint

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Background: Verify if the elevated preoperative International Normalized Ratio (INR) can increase transfusion and complication rate in primary total hip arthroplasty.Methods: We retrospectively reviewed the database of adults who underwent primary total hip arthroplasty between 2014 to 2018 by the same surgeon. 552 cases were assigned into 3 groups by preoperative INR class: INR≤0.9, 0.9＜INR＜1.0, and INR≥1.0 eventually. We regarded the transfusion rate as the primary outcome. We also included perioperative blood loss, maximum Hb-drop, postoperative anemia needs medicine, length of stay (LOS), re-operation, the complication rate in 90 days and mortality as the secondary outcomes. Univariable analyses were utilized to compare baselines and outcomes between groups. Binary Logistic Regression was used to adjust differences of baselines among groups.Results: All the cases had an INR＜1.5. Among all the cases, 93(16.8%) had INR≤0.9, 268 (48.6%) had 0.9＜INR＜1.0, and 191 (34.6%) had INR≥1.0, respectively. In the univariable analyses, with the INR elevated, The transfusion rates increased from 1.08% for INR≤0.9, 1.12% for 0.9＜INR＜1.0 to 5.76% for INR≥1.0 (p＜0.05). The overall complication rate increased from 10.8% for INR≤0.9, 16.4% for 0.9＜INR＜1.0 to 22.5% for INR≥1.0 (p＜0.05). When controlling for the demographics and comorbidities characteristics, there was no statistically significant difference when evaluating the odds of transfusion nor overall complication rate between the groups (p＞0.05).Conclusions: The transfusion and complication rate cannot increase along with the INR elevated in primary THA. With the improvement of arthroplasty protocol and use of tranexamic acid, the INR＜1.5 was still a conventional safe threshold.

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International normalized ratio for the guidance of warfarin treatment in elderly patients after cardiac valve replacement

Cited by 5 publications

References 19 publications

Mechanical valve replacement without anticoagulation: a case report

Mechanical valve replacement without anticoagulation: a case report

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

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