Document Detail


Optimal level of oral anticoagulant therapy for the prevention of arterial thrombosis in patients with mechanical heart valve prostheses, atrial fibrillation, or myocardial infarction: a prospective study of 4202 patients.
MedLine Citation:
PMID:  19597069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Oral anticoagulant therapy is effective for the prevention of arterial thromboembolism in various patient groups. The increased risk of hemorrhage remains the major drawback to this therapy and is associated with the intensity of anticoagulation. Finding the optimal intensity at which the overall incidence rate of both bleeding and thromboembolic events is minimized represents a way to improve the safety of oral anticoagulant treatment. METHODS: We evaluated all patients visiting the Leiden Anticoagulation Clinic with mechanical heart valve prostheses, atrial fibrillation, or myocardial infarction from 1994 to 1998. Untoward events were major thromboembolism and major hemorrhage. We calculated intensity-specific incidence rates of untoward events to assess the optimal intensity per indication of treatment. We enrolled 4202 patients for a total of 7788 patient-years. RESULTS: A total of 3226 hospital admissions were reported, 306 owing to an untoward event. Incidence rates of untoward events were around 4% per year for all indications: 4.3 (95% confidence interval [CI], 3.1-5.6) for patients with mechanical heart valve prostheses, 4.3 (95% CI, 3.7-5.1) for patients with atrial fibrillation, and 3.6 per year (95% CI, 3.0-4.4) for patients treated after a myocardial infarction. The optimal intensity of anticoagulation for patients with mechanical heart valve prostheses was an international normalized ratio (INR) of 2.5 to 2.9; for patients with atrial fibrillation, an INR of 3.0 to 3.4; and for patients after myocardial infarction, an INR of 3.5 to 3.9. CONCLUSION: Our study suggests target INRs of 3.0 for patients with mechanical heart valve prostheses and atrial fibrillation and 3.5 after myocardial infarction as a starting point in future clinical trials.
Authors:
Marieke Torn; Suzanne C Cannegieter; Ward L E M Bollen; Felix J M van der Meer; Ernst E van der Wall; Frits R Rosendaal
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  169     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-14     Completed Date:  2009-08-06     Revised Date:  2009-11-27    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1203-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Clinical Epidemiology, Leiden University Medical Center, 2300 RC Leiden, the Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Aged
Anticoagulants / administration & dosage*
Arterial Occlusive Diseases / epidemiology,  etiology,  prevention & control*
Atrial Fibrillation / complications*,  drug therapy
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Heart Valve Diseases / complications*,  drug therapy,  surgery
Heart Valve Prosthesis*
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy
Netherlands / epidemiology
Prospective Studies
Questionnaires
Thrombosis / epidemiology,  etiology,  prevention & control*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Comment In:
Arch Intern Med. 2009 Nov 23;169(21):2032; author reply 2033   [PMID:  19933969 ]
Arch Intern Med. 2009 Nov 23;169(21):2032-3; author reply 2033   [PMID:  19933968 ]

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