Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGJin-hua ¹ , GUANChao-fan ¹ , CHENZhi-jie ² , TIANHuang-long ¹ ,  CAOHua ³

1. Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, China;
2. Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China;
3. Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China;

Corresponding?author：

CAOHua, Email: caohua69@hotmail.com

Keywords：

Mechanical heart valve replacement; Warfarin; Anticoagulation intensity; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20140219

Video：

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Objective To systematically review therapy-related complications incidences of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement, and to explore the suitable anticoagulation intensity of warfarin. Methods We electronically searched The Cochrane Library (Issue 2, 2013), EMbase, PubMed, CNKI, CBM, WanFang Data and VIP for studies about therapy-related complications rates of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement from inception to March 2013. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 7 studies involving 3 787 cases were finally included, 2 985 cases in Group A (targeted INR≤2.3) and 802 cases in Group B (targeted INR > 2.3). The results of meta-analysis showed that, compared with Group B, the total therapy-related complications incidence of warfarin with different anticoagulation intensity significantly decreased in Group A (OR=0.35, 95%CI 0.28 to 0.44, P < 0.000 01). The incidence of hemorrhage in Group A (OR=0.15, 95%CI 0.08 to 0.27, P < 0.000 01) was lower than that in Group B. However, the incidence of embolism in Group A was higher than that in Group B (OR=2.77, 95%CI 1.54 to 4.98, P=0.000 7). Conclusion Applying low-intensity anticoagulation for Chinese patients after mechanical heart valve replacement could reduce the overall incidences of anticoagulation-related complications and hemorrhage, but it could also significantly increase the incidence of thrombosis.

Citation： ZHANGJin-hua, GUANChao-fan, CHENZhi-jie, TIANHuang-long, CAOHua. Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1361-1366. doi: 10.7507/1672-2531.20140219 Copy

1.	?Stein PD, Alpert JS, Bussey HI, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 2001, 119(1 Suppl):220S-227S.
2.	Kayali MT, Fetieh MW, Abdulsalam MA, et al. Thrombotic obstruction of bileaflet mechanical prosthetic heart valves:early diagnosis and management. J Cardiovasc Surg (Torino), 1998, 39(3):331-335.
3.	張進華, 劉茂柏, 官超凡, 等.網上抗凝門診的建立與實踐.中國藥學雜志, 2014, 49(16):99-101.
4.	Wigle P, Hein B, Bloomfield HE, et al. Updated guidelines on outpatient anticoagulation. Am Fam Physician, 2013, 87(8):556-566.
5.	Lee MT, Klein TE. Pharmacokinetics of warfarin:challenges and opportunities. J Hum Genet, 2013, 58(6):334-338.
6.	Wallace JL, Reaves AB, Tolley EA, et al. Comparison of initial warfarin response in obese patients versus non-obese patients. J Thromb Thrombolysis, 2013, 36(1):96-101.
7.	王斌, 徐志云, 葉小飛.華人心臟機械瓣膜置換術后華法林抗凝強度標準的系統評價.國際心血管病雜志, 2011, 37(6):361-365.
8.	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-660.
9.	劉文平, 黃彩云.國產奧美拉唑治療急性非靜脈曲張性上消化道出血的Meta分析.中國循證醫學雜志, 2013, 13(6):723-727.
10.	楊莉萍, 謝婧, 劉瑤, 等. CYP2C19^2、^3基因多態性與氯吡格雷臨床療效相關性的系統評.中國循證醫學雜志, 2012, 12(9):1063-1070.
11.	孟旭, 李金鐘, 劉巖, 等.人工機械瓣膜置換術后口服抗凝藥的抗凝治療強度標準.中華心血管病雜志, 2004, 32(7):618-621.
12.	王志偉, 徐明星, 計樂群.心臟瓣膜置換術后低強度抗凝研究.中華實驗外科雜志, 2005, 22(4):484-485.
13.	王勝鵬, 王忠明.云南地區瓣膜置換術后低強度抗凝的臨床研究.碩士學位論文.云南:昆明醫學院, 2007.
14.	俞經生, 葛建軍, 周正春.心臟瓣膜置換術后抗凝治療的臨床研究.安徽醫藥, 2008, 12(9):820-821.
15.	白銀, 方剛.寧夏地區機械瓣膜置換術后抗凝治療的回顧分析.寧夏回族自治區:寧夏醫科大學, 2011.
16.	郝占平, 唐英杰, 丁敏, 等.機械心臟瓣膜置換術后遠期抗凝狀態臨床觀察及意義.陜西醫學雜志, 2011, 40(7):827-828.
17.	徐博, 劉金城, 俞世強, 等.人工機械心臟瓣膜置換術后抗凝治療強度與并發癥發生率的關系.心臟雜志, 2012, 24(6):749-752.
18.	Karl H, Gulshan KS, William GH, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4):1152-1158.
19.	Sand ME, Naftel DC, Blackstone EH, et al. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg, 1987, 94(2):208-219.
20.	Claiborne TE, Xenos M, Sheriff J, et al. Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation. ASAIO J, 2013, 59(3):275-283.
21.	Alexander GG, Jack H, John G, et al. Randomized comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet, 1998, 331(8597):1242-1245.
22.	Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease:Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl):e576S-600S.
23.	Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 2011, 365(21):2002-2012.
24.	Wofford JL, Wells MD, Singh S. Best strategies for patient education about anticoagulation with warfarin:a systematic review. BMC Health Serv Res, 2008, 14(8):40.
25.	Baker JW, Pierce KL, Ryals CA. INR goal attainment and oral anticoagulation knowledge in an anticoagulation clinic in a Veterans Affairs medical center. J Manag Care Pharm, 2011, 17(2):133-142.
26.	Garton L, Crosby JF. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis, 2011, 32(4):426-430.

1. ?Stein PD, Alpert JS, Bussey HI, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest, 2001, 119(1 Suppl):220S-227S.
2. Kayali MT, Fetieh MW, Abdulsalam MA, et al. Thrombotic obstruction of bileaflet mechanical prosthetic heart valves:early diagnosis and management. J Cardiovasc Surg (Torino), 1998, 39(3):331-335.
3. 張進華, 劉茂柏, 官超凡, 等.網上抗凝門診的建立與實踐.中國藥學雜志, 2014, 49(16):99-101.
4. Wigle P, Hein B, Bloomfield HE, et al. Updated guidelines on outpatient anticoagulation. Am Fam Physician, 2013, 87(8):556-566.
5. Lee MT, Klein TE. Pharmacokinetics of warfarin:challenges and opportunities. J Hum Genet, 2013, 58(6):334-338.
6. Wallace JL, Reaves AB, Tolley EA, et al. Comparison of initial warfarin response in obese patients versus non-obese patients. J Thromb Thrombolysis, 2013, 36(1):96-101.
7. 王斌, 徐志云, 葉小飛.華人心臟機械瓣膜置換術后華法林抗凝強度標準的系統評價.國際心血管病雜志, 2011, 37(6):361-365.
8. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-660.
9. 劉文平, 黃彩云.國產奧美拉唑治療急性非靜脈曲張性上消化道出血的Meta分析.中國循證醫學雜志, 2013, 13(6):723-727.
10. 楊莉萍, 謝婧, 劉瑤, 等. CYP2C19^*2、^*3基因多態性與氯吡格雷臨床療效相關性的系統評.中國循證醫學雜志, 2012, 12(9):1063-1070.
11. 孟旭, 李金鐘, 劉巖, 等.人工機械瓣膜置換術后口服抗凝藥的抗凝治療強度標準.中華心血管病雜志, 2004, 32(7):618-621.
12. 王志偉, 徐明星, 計樂群.心臟瓣膜置換術后低強度抗凝研究.中華實驗外科雜志, 2005, 22(4):484-485.
13. 王勝鵬, 王忠明.云南地區瓣膜置換術后低強度抗凝的臨床研究.碩士學位論文.云南:昆明醫學院, 2007.
14. 俞經生, 葛建軍, 周正春.心臟瓣膜置換術后抗凝治療的臨床研究.安徽醫藥, 2008, 12(9):820-821.
15. 白銀, 方剛.寧夏地區機械瓣膜置換術后抗凝治療的回顧分析.寧夏回族自治區:寧夏醫科大學, 2011.
16. 郝占平, 唐英杰, 丁敏, 等.機械心臟瓣膜置換術后遠期抗凝狀態臨床觀察及意義.陜西醫學雜志, 2011, 40(7):827-828.
17. 徐博, 劉金城, 俞世強, 等.人工機械心臟瓣膜置換術后抗凝治療強度與并發癥發生率的關系.心臟雜志, 2012, 24(6):749-752.
18. Karl H, Gulshan KS, William GH, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4):1152-1158.
19. Sand ME, Naftel DC, Blackstone EH, et al. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg, 1987, 94(2):208-219.
20. Claiborne TE, Xenos M, Sheriff J, et al. Toward optimization of a novel trileaflet polymeric prosthetic heart valve via device thrombogenicity emulation. ASAIO J, 2013, 59(3):275-283.
21. Alexander GG, Jack H, John G, et al. Randomized comparison of two intensities of oral anticoagulant therapy after tissue heart valve replacement. Lancet, 1998, 331(8597):1242-1245.
22. Whitlock RP, Sun JC, Fremes SE, et al. Antithrombotic and thrombolytic therapy for valvular disease:Antithrombotic Therapy and Prevention of Thrombosis, 9^th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl):e576S-600S.
23. Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 2011, 365(21):2002-2012.
24. Wofford JL, Wells MD, Singh S. Best strategies for patient education about anticoagulation with warfarin:a systematic review. BMC Health Serv Res, 2008, 14(8):40.
25. Baker JW, Pierce KL, Ryals CA. INR goal attainment and oral anticoagulation knowledge in an anticoagulation clinic in a Veterans Affairs medical center. J Manag Care Pharm, 2011, 17(2):133-142.
26. Garton L, Crosby JF. A retrospective assessment comparing pharmacist-managed anticoagulation clinic with physician management using international normalized ratio stability. J Thromb Thrombolysis, 2011, 32(4):426-430.

Chinese Journal of Evidence-Based Medicine

Therapy-related Complication Incidences of Warfarin with Different Anticoagulation Intensity in Chinese after Mechanical Heart Valve Replacement: A Systematic Review

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