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Do Patients With High CHA₂DS₂-VASc Scores Need High Intensity of Anticoagulants After Valve Surgery?

2018; Japanese Circulation Society; Volume: 82; Issue: 4 Linguagem: Inglês

10.1253/circj.cj-17-1172

1347-4820

Hsi‐Yu Yu, Ming‐Hsien Lin, Lian‐Yu Lin, Chih‐Hsien Wang, Nai‐Hsin Chi, Yih‐Sharng Chen,

Acute Myocardial Infarction Research

Asian patients on warfarin therapy usually have lower international normalized ratio (INR) intensities than those recommended by Western clinical practice guidelines. This study evaluated whether a high INR reduces the incidence of thromboembolism (TE) or bleeding events in Asian patients with high CHA2DS2-VASc scores after valve surgery.Methods and Results:Data of adult patients after valve surgery were retrieved from an integrated healthcare information system of a single hospital between 2014 and 2016. The INR was derived from the closest laboratory data before the index outpatient-clinic visit date. The endpoint of every record was determined as emergency room visit or hospitalization because of TE or bleeding event. A total of 37 TE or bleeding events were retrieved from 8,207 records; the annual incidence rate were 1.2% and 2.8% for low (0-2) and high (3-8) CHA2DS2-VASc score groups, respectively (P=0.007). The incidence rates were lowest for both groups at an INR of 1.5-2.0. High INR intensities did not reduce TE or bleeding incidence. INR >3.0 was associated with increased TE or bleeding incidence in the high-score group (6.8%/year vs. 2.0%/year, P=0.079).The optimal INR is 1.5-2.5 for low- or high-score Asian patients after valve surgery. INR >3.0 was associated with increased TE or bleeding incidence in the high-score group.