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

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  • Yu Hsi-Yu
    Department of Surgery, College of Medicine, National Taiwan University Hospital and National Taiwan University
  • Lin Ming-Hsien
    Department of Surgery, National Taiwan University Hospital
  • Lin Lian-Yu
    Department of Internal Medicine, College of Medicine, National Taiwan University Hospital and National Taiwan University
  • Wang Chih-Hsien
    Department of Surgery, College of Medicine, National Taiwan University Hospital and National Taiwan University
  • Chi Nai-Hsin
    Department of Surgery, College of Medicine, National Taiwan University Hospital and National Taiwan University
  • Chen Yih-Sharng
    Department of Surgery, College of Medicine, National Taiwan University Hospital and National Taiwan University

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タイトル別名
  • Do Patients With High CHA<sub>2</sub>DS<sub>2</sub>-VASc Scores Need High Intensity of Anticoagulants After Valve Surgery?

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<p>Background: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.</p><p>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).</p><p>Conclusions: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.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 82 (4), 1186-1194, 2018

    一般社団法人 日本循環器学会

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