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Observational Study
. 2021 Mar 6;26(5):1425.
doi: 10.3390/molecules26051425.

Comparison of Anticoagulation Quality between Acenocoumarol and Warfarin in Patients with Mechanical Prosthetic Heart Valves: Insights from the Nationwide PLECTRUM Study

Danilo Menichelli  1 , Daniela Poli  2 , Emilia Antonucci  3 , Vittoria Cammisotto  4 , Sophie Testa  5 , Pasquale Pignatelli  1 , Gualtiero Palareti  3 , Daniele Pastori  1 , The Italian Federation Of Anticoagulation Clinics Fcsa
Affiliations
Observational Study

Comparison of Anticoagulation Quality between Acenocoumarol and Warfarin in Patients with Mechanical Prosthetic Heart Valves: Insights from the Nationwide PLECTRUM Study

Danilo Menichelli et al. Molecules. .

Abstract

Vitamin K antagonists are indicated for the thromboprophylaxis in patients with mechanical prosthetic heart valves (MPHV). However, it is unclear whether some differences between acenocoumarol and warfarin in terms of anticoagulation quality do exist. We included 2111 MPHV patients included in the nationwide PLECTRUM registry. We evaluated anticoagulation quality by the time in therapeutic range (TiTR). Factors associated with acenocoumarol use and with low TiTR were investigated by multivariable logistic regression analysis. Mean age was 56.8 ± 12.3 years; 44.6% of patients were women and 395 patients were on acenocoumarol. A multivariable logistic regression analysis showed that patients on acenocoumarol had more comorbidities (i.e., ≥3, odds ratio (OR) 1.443, 95% confidence interval (CI) 1.081-1.927, p = 0.013). The mean TiTR was lower in the acenocoumarol than in the warfarin group (56.1 ± 19.2% vs. 61.6 ± 19.4%, p < 0.001). A higher prevalence of TiTR (<60%, <65%, or <70%) was found in acenocoumarol users than in warfarin ones (p < 0.001 for all comparisons). Acenocoumarol use was associated with low TiTR regardless of the cutoff used at multivariable analysis. A lower TiTR on acenocoumarol was found in all subgroups of patients analyzed according to sex, hypertension, diabetes, age, valve site, atrial fibrillation, and INR range. In conclusion, anticoagulation quality was consistently lower in MPHV patients on acenocoumarol compared to those on warfarin.

Keywords: acenocoumarol; anticoagulation; mechanical valve; time in therapeutic range; warfarin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Association among acenocoumarol and low time in therapeutic range using different cutoff values in multivariable regression analysis.
See this image and copyright information in PMC

References

    1. Iung B., Vahanian A. Epidemiology of valvular heart disease in the adult. Nat. Rev. Cardiol. 2011;8:162–172. doi: 10.1038/nrcardio.2010.202. - DOI - PubMed
    1. Roumieh M., Ius F., Tudorache I., Ismail I., Fleissner F., Haverich A., Cebotari S. Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: Long-term results. Eur. J. Cardio-Thorac. Surg. 2014;48:129–136. doi: 10.1093/ejcts/ezu392. - DOI - PubMed
    1. Menichelli D., Ettorre E., Pani A., Violi F., Pignatelli P., Pastori D. Update and Unmet Needs on the Use of Nonvitamin K Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation. Curr. Probl. Cardiol. 2021;46:100410. doi: 10.1016/j.cpcardiol.2019.02.002. - DOI - PubMed
    1. Dentali F., Pignatelli P., Malato A., Poli D., Di Minno M.N.D., Di Gennaro L., Rancan E., Pastori D., Grifoni E., Squizzato A., et al. Incidence of thromboembolic complications in patients with atrial fibrillation or mechanical heart valves with a subtherapeutic international normalized ratio: A prospective multicenter cohort study. Am. J. Hematol. 2012;87:384–387. doi: 10.1002/ajh.23119. - DOI - PubMed
    1. Pastori D., Pignatelli P., Saliola M., Carnevale R., Vicario T., Del Ben M., Cangemi R., Barillà F., Lip G.Y., Violi F. Inadequate anticoagulation by Vitamin K Antagonists is associated with Major Adverse Cardiovascular Events in patients with atrial fibrillation. Int. J. Cardiol. 2015;201:513–516. doi: 10.1016/j.ijcard.2015.08.054. - DOI - PubMed

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