Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement
Abstract Importance An inadequate number of studies focused on Asian populations have investigated the safety of warfarin usage among Asian patients with tissue valve aortic valve replacement (AVR) or mitral valve replacement (MVR). Objective This study aimed to identify the optimal international no...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12872-025-04837-y |
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| author | Tang-Yu Liu Yi‐Hsin Chan Victor Chien-Chia Wu Dong-Yi Chen Kuo-Chun Hung Fu-Chih Hsiao Ying-Chang Tung Chia-Pin Lin Pao-Hsien Chu Shao-Wei Chen |
| author_facet | Tang-Yu Liu Yi‐Hsin Chan Victor Chien-Chia Wu Dong-Yi Chen Kuo-Chun Hung Fu-Chih Hsiao Ying-Chang Tung Chia-Pin Lin Pao-Hsien Chu Shao-Wei Chen |
| author_sort | Tang-Yu Liu |
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| description | Abstract Importance An inadequate number of studies focused on Asian populations have investigated the safety of warfarin usage among Asian patients with tissue valve aortic valve replacement (AVR) or mitral valve replacement (MVR). Objective This study aimed to identify the optimal international normalized ratio (INR) range for Asian patients during a 1-year follow-up after tissue valve replacement. Design, setting, participants We conducted a retrospective cohort study of patients who underwent tissue valve AVR, MVR, and double valve replacement (DVR) between January 1, 2001, and December 31, 2018. Data were sourced from the Chang Gung Research Database, an electronic structured medical database covering 4 regional hospitals and 3 medical centers. The exposure of interest was INR level. Main outcomes and measures The outcomes of primary and secondary interest were composite thromboembolic events and bleeding events during the 1-year follow-up, respectively. The relationship between INR level and the risk of thromboembolic events was explored using a logistic regression model in which the INR value was treated as a flexible restricted cubic spline. Because having atrial fibrillation (AF) greatly would greatly affect the INR control result, the analysis was stratified by AF status. Results A total of 1059 participants were eligible for this study. The mean patient age was 65.5 (11.9) years; 592 (55.9%) participants were men, and 467 (44.1%) were women. A total of 447 had AF and 612 did not. The lowest bleeding risk was observed at an INR level around 1.9 to 2.0. An INR level of 1.84 (hazard ratio [HR], 0.49; 95% confidence interval [CI]: 0.36–0.67) and 1.7 (HR, 0.78; 95% CI: 0.62–0.99) corresponded to the lowest risk of thromboembolic events in patients with pre-existing AF and those without, respectively. The INR level corresponding to the lowest risk of thromboembolic events was approximately 1.7 in patients without AF but with MVR, DVR, or isolated AVR. Conclusions and relevance For patients who underwent tissue valve replacement, the bleeding risk was elevated when the INR was greater than 2.0, but the risk of thromboembolic event increased only when the INR was lower than 1.84 in the AF group and 1.7 in the non-AF group, regardless of whether the patient received AVR, MVR, or DVR. |
| format | Article |
| id | doaj-art-d813fb1c50cf4435893d3f2b0ab0b5fb |
| institution | DOAJ |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-d813fb1c50cf4435893d3f2b0ab0b5fb2025-08-20T03:16:39ZengBMCBMC Cardiovascular Disorders1471-22612025-05-0125111210.1186/s12872-025-04837-yAnticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacementTang-Yu Liu0Yi‐Hsin Chan1Victor Chien-Chia Wu2Dong-Yi Chen3Kuo-Chun Hung4Fu-Chih Hsiao5Ying-Chang Tung6Chia-Pin Lin7Pao-Hsien Chu8Shao-Wei Chen9American College of CardiologyDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDepartment of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityDivision of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung UniversityAbstract Importance An inadequate number of studies focused on Asian populations have investigated the safety of warfarin usage among Asian patients with tissue valve aortic valve replacement (AVR) or mitral valve replacement (MVR). Objective This study aimed to identify the optimal international normalized ratio (INR) range for Asian patients during a 1-year follow-up after tissue valve replacement. Design, setting, participants We conducted a retrospective cohort study of patients who underwent tissue valve AVR, MVR, and double valve replacement (DVR) between January 1, 2001, and December 31, 2018. Data were sourced from the Chang Gung Research Database, an electronic structured medical database covering 4 regional hospitals and 3 medical centers. The exposure of interest was INR level. Main outcomes and measures The outcomes of primary and secondary interest were composite thromboembolic events and bleeding events during the 1-year follow-up, respectively. The relationship between INR level and the risk of thromboembolic events was explored using a logistic regression model in which the INR value was treated as a flexible restricted cubic spline. Because having atrial fibrillation (AF) greatly would greatly affect the INR control result, the analysis was stratified by AF status. Results A total of 1059 participants were eligible for this study. The mean patient age was 65.5 (11.9) years; 592 (55.9%) participants were men, and 467 (44.1%) were women. A total of 447 had AF and 612 did not. The lowest bleeding risk was observed at an INR level around 1.9 to 2.0. An INR level of 1.84 (hazard ratio [HR], 0.49; 95% confidence interval [CI]: 0.36–0.67) and 1.7 (HR, 0.78; 95% CI: 0.62–0.99) corresponded to the lowest risk of thromboembolic events in patients with pre-existing AF and those without, respectively. The INR level corresponding to the lowest risk of thromboembolic events was approximately 1.7 in patients without AF but with MVR, DVR, or isolated AVR. Conclusions and relevance For patients who underwent tissue valve replacement, the bleeding risk was elevated when the INR was greater than 2.0, but the risk of thromboembolic event increased only when the INR was lower than 1.84 in the AF group and 1.7 in the non-AF group, regardless of whether the patient received AVR, MVR, or DVR.https://doi.org/10.1186/s12872-025-04837-yINRWarfarinBioprosthetic valve replacement |
| spellingShingle | Tang-Yu Liu Yi‐Hsin Chan Victor Chien-Chia Wu Dong-Yi Chen Kuo-Chun Hung Fu-Chih Hsiao Ying-Chang Tung Chia-Pin Lin Pao-Hsien Chu Shao-Wei Chen Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement BMC Cardiovascular Disorders INR Warfarin Bioprosthetic valve replacement |
| title | Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement |
| title_full | Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement |
| title_fullStr | Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement |
| title_full_unstemmed | Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement |
| title_short | Anticoagulation therapy and related outcomes among Asian patients after bioprosthetic valve replacement |
| title_sort | anticoagulation therapy and related outcomes among asian patients after bioprosthetic valve replacement |
| topic | INR Warfarin Bioprosthetic valve replacement |
| url | https://doi.org/10.1186/s12872-025-04837-y |
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