Thromboembolic and Bleeding Complications Following St. Jude Medical Valve Replacement

Hering, Detlef; Piper, Cornelia; Bergemann, R; Hillenbach, Carina; Dahm, Manfred; Huth, Christof; Horstkotte, Dieter

doi:10.1378/chest.127.1.53

Cited by 135 publications

(19 citation statements)

References 25 publications

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“…For patients with AF who have mechanical heart valves, warfarin is recommended and the target international normalized ratio (INR) intensity (2.0 to 3.0 or 2.5 to 3.5) should be based on the type and location of the prosthesis (174-176). (Level of Evidence: B) …”

Section: Prevention Of Thromboembolismmentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,529

1,139

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Section: Prevention Of Thromboembolismmentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,529

1,139

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“…Previous researchers have focused primarily on the PoT in control or PoR in control for a specified target range [2], [3], [5], [6], [8], [11]. However, the PoR or PoT too high/too low are also likely to be important because different clinical events are associated with high and low INR levels and any target INR range represents an attempt to balance the competing risks of thromboembolic and bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

Implications of Using Different Methods to Characterise Anticoagulant Control in Patients with Second Generation Mechanical Heart Valve Prostheses

et al. 2014

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ObjectiveCharacterisation of anticoagulant control is fundamental to investigations of its association with clinical outcome. Anticoagulant control depends on several factors. This paper aims to illustrate the implications of different methods for measuring and analysing anticoagulant control in patients with second generation mechanical heart valve prostheses.MethodsInternational normalised ratio (INR) data collected during the 10-year follow-up of a randomised controlled trial were analysed. We considered the influence of: 3 different target INR ranges; anticoagulant control expressed as the proportion of INR readings (PoR) vs. anticoagulant control follow-up time (PoT); 3 ways of describing the profile of anticoagulant control over time.ResultsDifferent target INR ranges dramatically influenced derived measures of anticoagulant control; the PoT within the target range varied from 88% for the widest to 28% for narrowest range. Overall distributions of PoR and PoT observations were similar but differed by up to ±20% for individuals; PoT exceeded PoR when control was good but was less than PoR when control was poor. Classifying PoT outside the target range showed that widely varying combinations of PoT too high and too low are possible across individuals.ConclusionsResearchers' choices about methods for measuring and quantifying anticoagulant control markedly influence the values derived from INR readings. The use of different methods across studies makes it difficult or impossible to compare findings and to establish an evidence base for clinical practice. Methods for quantifying anticoagulant control should be standardised.

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“…Without anticoagulant treatment, the annualized rate of thrombosis for older type mechanical valves is 8.6% [12], and those in the mitral position are more thrombogenic than those in the aortic position [13]. There is lack of data regarding the risk with newer valves, which are ostensibly lower risk [1].…”

Section: Mechanical Heart Valvesmentioning

confidence: 99%

Update in bridging anticoagulation

Kaatz

Paje

2011

J Thromb Thrombolysis

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Patients treated with a vitamin K antagonist may require interruption of their anticoagulation prior to an invasive procedure or surgery, and as a result, may be placed at a higher risk for thromboembolic events during this time. Either low-molecular-weight heparin (LMWH) or unfractionated heparin is frequently used to bridge the gap in anticoagulation treatment because of their relatively rapid onset and offset of action compared to warfarin. Despite the lack of randomized trials supporting the efficacy of this bridging therapy, guidelines have been developed to assist providers with this common clinical challenge. Key issues in bridging therapy include identifying patients who can safely undergo an invasive procedure while continuing their vitamin K antagonist, identifying those who will likely gain the most benefit from bridging anticoagulation, and determining the optimal dose and timing of parenteral anticoagulants in the perioperative period.

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Thromboembolic and Bleeding Complications Following St. Jude Medical Valve Replacement

Cited by 135 publications

References 25 publications

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

Implications of Using Different Methods to Characterise Anticoagulant Control in Patients with Second Generation Mechanical Heart Valve Prostheses

Update in bridging anticoagulation

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