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. 2021 May;75(5):e14064.
doi: 10.1111/ijcp.14064. Epub 2021 Feb 11.

Sex-based difference in anticoagulated patients with mechanical prosthetic heart valves and long-term mortality risk

Daniele Pastori  1 , Daniela Poli  2 , Emilia Antonucci  3 , Danilo Menichelli  1 , Francesco Violi  1 , Gualtiero Palareti  3 , Pasquale Pignatelli  1 ; Italian Federation of Anticoagulation Clinics (FCSA)
Collaborators, Affiliations

Sex-based difference in anticoagulated patients with mechanical prosthetic heart valves and long-term mortality risk

Daniele Pastori et al. Int J Clin Pract. 2021 May.

Abstract

Background: Vitamin K antagonists (VKAs) reduce thromboembolism in patients with mechanical prosthetic heart valves (MPHV). It is unclear whether a sex-based difference in MPHV patients regarding valve site, anticoagulation quality, and mortality risk does exist.

Methods: We analysed 2111 MPHV patients from the nationwide PLECTRUM study promoted by the Italian Federation of Anticoagulation Clinics (FCSA). We analysed the site of MPHV, anticoagulation quality, as assessed by the time in therapeutic range (TiTR), and mortality risk in women and men.

Results: The mean age of the patients was 56.8 ± 12.3 years. Women were older with a lower prevalence of ischemic heart disease and smoking habit and a higher prevalence of atrial fibrillation at baseline. Aortic MPHV was more frequent in men (74.7% vs 43.3%, P < .001), whereas mitral (41.1% vs 17.6%, P < .001) and mitro-aortic (15.6% vs 7.7%, P < .001) MPVH in women. The association between female sex and mitral/mitro-aortic site remained at multivariable logistic regression analysis (Odds Ratio 3.623, 95% Confidence Interval [CI] 2.947-4.455, P < .001). Regarding anticoagulation quality, women showed lower mean TiTR (63.0 ± 19.4 vs 57.5 ± 19.2, P < .001), and a higher proportion of TiTR < 60% (54.9% vs 43.3%, P < .001). During a mean follow-up of 123 months (21 665 pt-years), 152 deaths occurred (0.7%/year); 83 in the aortic (0.63%/year) and 69 in the mitral/mitro-aortic (0.81%/year) group. At multivariable Cox proportional hazard regression analysis, female sex was not associated with mortality (HR 0.953, 95%CI 0.678 1.340, P = .783).

Conclusions: Female sex is independently associated with mitral/mitro-aortic MPHV. Despite a lower TiTR in women, mortality risk did not differ between the two groups.

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References

REFERENCES

    1. Diaz R, Hernandez-Vaquero D, Alvarez-Cabo R, et al. Long-term outcomes of mechanical versus biological aortic valve prosthesis: Systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2019;158(3):706-714.e718.
    1. Roumieh M, Ius F, Tudorache I, et al. Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: long-term results. Eur J Cardiothorac Surg. 2015;48(1):129-136.
    1. Schelbert EB, Vaughan-Sarrazin MS, Welke KF, Rosenthal GE. Valve type and long-term outcomes after aortic valve replacement in older patients. Heart. 2008;94(9):1181-1188.
    1. Saito S, Tsukui H, Iwasa S, et al. Bileaflet mechanical valve replacement: an assessment of outcomes with 30 years of follow-up. Interact Cardiovasc Thorac Surg. 2016;23(4):599-607.
    1. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2791.