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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2016 February;57(1):90-9
Is low anticoagulation intensity more beneficial for patients with bileaflet mechanical mitral valves? A meta-analysis
Zhe XU 1, Zhi-Ping WANG 1, Jing-Song OU 1, Sheng-Li YIN 1, Li-Juan LIU 2, Xi ZHANG 1 ✉
1 Division of Cardiac Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; 2 Division of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
BACKGROUND: For the mitral valve replacement (MVR) using the lowest thrombogenic risk bileaflet valves (St. Jude Medical [St Paul, MN, USA], Carbomedics [Austin, TX, USA] and On-X [Austin, TX, USA]), excellent results can be achieved by adopting the anticoagulation intensity (median INR<2.5) which is lower than the recommended intensity (INR:2.5~3.5). Our aim was to provide a pooled estimate of potential benefit from clinical studies using low anticoagulation intensity and high intensity in these patients.
METHODS: Relevant studies published before February 2014 were searched through a number of digital databases (MEDLINE, EMBASE, Cochrane Library, etc.). They were pooled by SPSS19.0 using the random effect method in three fields: occurrence rate of major thromboembolism, major hemorrhage and major total events. Fourteen studies with 3595 patients were included. The follow-up period was 12,846.6 patient-years.
RESULTS: Pooled estimates indicated reduction in major hemorrhage (RR:0.420, 95%CI: 0.296~0.595, P<0.001) and major total events (RR: 0.738, 95%CI: 0.604~0.902, P=0.003) in the low intensity group. No difference was noted in major thromboembolism (RR: 1.045, 95%CI: 0.814~1.341, P=0.75).
CONCLUSION: Compared with the recommended high intensity, low anticoagulation intensity (median INR<2.5) may be more beneficial for the MVR patients using the lowest thrombogenic risk bileaflet valves. We recommended an INR between 2.0 and 2.5, with a median INR of 2.3 for these MVR patients.