| 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 |
Related Documents
:
|
10220649 - Echocardiographic evaluation of patients with primary antiphospholipid syndrome. 17123649 - Large recesses associated with left ventricular noncompaction: an unusual presentation ... 12730559 - Oral anticoagulation in patients after cerebral ischemia of arterial origin and risk of... 12126819 - Aspirin and coumadin after acute coronary syndromes (the aspect-2 study): a randomised ... 10613979 - Anticoagulation in congestive cardiomyopathy: steps toward defining the great unknown. 22225769 - Measuring passive myocardial stiffness in drosophila melanogaster to investigate diasto... 2537349 - Determinants of restenosis and lack of effect of dietary supplementation with eicosapen... 10736289 - Monoclonal anti-cd18 antibody prevents transcellular biosynthesis of cysteinyl leukotri... 22665549 - Pseudo-ischaemic ecg in a patient with amyotrophic lateral sclerosis surviving for a de... |
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. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| 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 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: re...
Next Document: Thrombomodulin as a marker for bleeding complications during warfarin treatment.