I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anaesthetic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Br J Haematol. 2020 Aug;190(4):588-593. doi: 10.1111/bjh.16528. Epub 2020 Feb 20.
Quality of warfarin therapy in patients with a mechanical prosthetic heart valve (MPHV) has been barely investigated. We analysed determinants of low time in the therapeutic range (TiTR <60%) in 2111 patients with MPHVs from the nationwide PLECTRUM study by the Italian Federation of Anticoagulation Clinics. Overall, 48·5% of patients had a TiTR of < 60%. At logistic regression analysis, arterial hypertension (odds ratio [OR] 1·502, P < 0·001), diabetes (OR 1·732, P < 0·001), heart failure (OR 1·484, P = 0·004), mitral site (vs. aortic) (OR 1·399, P = 0·006), international normalised ratio (INR) ranges of 2·5-3·5 (OR 2·575, P < 0·001) and 3·0-4·0 (OR 8·215, P < 0·001) associated with TiTR < 60%. TiTR is substantially suboptimal in MPHV patients, particularly in higher INR ranges.
机械心脏瓣膜置换患者（MPHV）的华法林治疗质量几乎未被研究过。我们分析了意大利抗凝临床联合会全国性 PLECTRUM 研究中 2111 例 MPHV 患者低治疗时间（TiTR <60%）的决定因素。总体而言，48.5%的患者 TiTR <60%。在逻辑回归分析中，高血压（比值比 [OR] 1.502，P<0.001）、糖尿病（OR 1.732，P<0.001）、心力衰竭（OR 1.484，P=0.004）、二尖瓣部位（与主动脉瓣）（OR 1.399，P=0.006）、国际标准化比值（INR）范围 2.5-3.5（OR 2.575，P<0.001）和 3.0-4.0（OR 8.215，P<0.001）与 TiTR <60%相关。MPHV 患者的 TiTR 明显不理想，尤其是在较高的 INR 范围内。
