Correlations between prothrombin time-international normalized ratio (PT-INR) monitoring frequency and long-term prognosis in patients with mechanical mitral valve replacement

doi:10.3877/cma.j.issn.2095-6568.2022.03.007

Abstract

Abstract:

Objective

To investigate correlations between monitoring frequency of prothrombin time-international normalized ratio (PT-INR) and long-term prognosis in patients after mechanical mitral valve (MMV) replacement.

Methods

Patients underwent MMV replacement in the First Affiliated Hospital with Nanjing Medical University and discharged from June 2013 to May 2018 were enrolled. Patients were followed with a telephone questionnaire survey. Based on monitoring intervals, patients were divided into frequent monitoring group (FMG) (monitoring intervals≤1 month) and infrequent monitoring group (IMG) (monitoring intervals >1 month). Primary endpoint was all-cause death' and secondary endpoints were ischemic stroke and major bleeding. Occurrences of endpoints in the two groups were analyzed.

Results

A total of 249 patients [age (47.06±6.88) years old, 98 male] were enrolled ,and 153 (61.4%) patients who finished questionnaire were included to analysis. Based on the year of operation, proportions of loss to follow-up were 76.1%, 51.3%, 26.7%, 32.3%,15.8%; proportions of frequent PT-INR monitoring were 36.4%,36.8%,42.4%,35.7%,83.3%, respectively. As post-operation time prolonged, proportions of loss to follow-up and infrequent PT-INR monitoring increased significantly (P<0.05). Eighty (52.3%) patients were grouped into FMG and 73 patients (47.7%) into IMG. There were 7 all-cause deaths, 6 ischemic stokes and 3 major bleedings in IMG, while no all-cause death, 1 ischemic stroke and 2 major bleedings happened in FMG. Compared with IMG, cumulative incidence of death in FMG was significantly lower (P=0.006).

Conclusion

As post-operation time prolonged, proportions of loss to follow-up and infrequent PT-INR monitoring increased significantly. Patients with infrequent monitoring had worse general prognosis than patients with frequent monitoring.

Key words: Heart valve prosthesis, Mechanical mitral valve, Warfarin, Prothrombin time-international normalized ratio (PT-INR), Monitoring frequency

Le Geng, Mingfang Li, Jiaxi Gu, Minghui Li, Haoliang Sun, Buqing Ni, Yongfeng Shao. Correlations between prothrombin time-international normalized ratio (PT-INR) monitoring frequency and long-term prognosis in patients with mechanical mitral valve replacement[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(03): 159-164.

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Figures/Tables 5

项目	纳入	剔除	P值
例数	153	96
人口学资料
男［例（%）］	59（38.6）	39（40.6）	0.75
年龄（岁， $x ¯ ± s$ ）	47.59±6.85	46.22±6.89	0.12
左心房内径（mm， $x ¯ ± s$ ）	51.11±9.96	51.37±11.35	0.85
左心室舒张末期内径（mm， $x ¯ ± s$ ）	52.60±9.16	50.58±7.10	0.69
左心室射血分数（%， $x ¯ ± s$ ）	59.89±6.63	61.93±6.38	0.18
肌酐清除率（ml/min， $x ¯ ± s$ ）	101.17±30.97	95.27±28.42	0.19
既往病史［例（%）］
高血压	25（16.3）	9（9.4）	0.17
糖尿病	4（2.6）	3（3.1）	0.81
冠心病	8（5.2）	1（1.0）	0.17
心房颤动	99（64.7）	58（60.4）	0.50
卒中	25（16.3）	6（6.2）	0.03
术中资料［例（%）］
单纯二尖瓣置换	88（57.5）	40（41.7）	0.02
二尖瓣+主动脉瓣双瓣置换	64（41.8）	52（54.2）	0.07
同期心房颤动消融	89（58.2）	57（59.4）	0.95
同期左心耳切除	99（64.7）	58（60.4）	0.50

项目	纳入	剔除	P值
例数	153	96
人口学资料
男［例（%）］	59（38.6）	39（40.6）	0.75
年龄（岁， $x ¯ ± s$ ）	47.59±6.85	46.22±6.89	0.12
左心房内径（mm， $x ¯ ± s$ ）	51.11±9.96	51.37±11.35	0.85
左心室舒张末期内径（mm， $x ¯ ± s$ ）	52.60±9.16	50.58±7.10	0.69
左心室射血分数（%， $x ¯ ± s$ ）	59.89±6.63	61.93±6.38	0.18
肌酐清除率（ml/min， $x ¯ ± s$ ）	101.17±30.97	95.27±28.42	0.19
既往病史［例（%）］
高血压	25（16.3）	9（9.4）	0.17
糖尿病	4（2.6）	3（3.1）	0.81
冠心病	8（5.2）	1（1.0）	0.17
心房颤动	99（64.7）	58（60.4）	0.50
卒中	25（16.3）	6（6.2）	0.03
术中资料［例（%）］
单纯二尖瓣置换	88（57.5）	40（41.7）	0.02
二尖瓣+主动脉瓣双瓣置换	64（41.8）	52（54.2）	0.07
同期心房颤动消融	89（58.2）	57（59.4）	0.95
同期左心耳切除	99（64.7）	58（60.4）	0.50

项目	2013-2014	2014-2015	2015-2016	2016-2017	2017-2018	P值
失访人数（例）	35	20	12	20	9
随访人数（例）	11	19	33	42	48
总人数（例）	46	39	45	62	57
失访比例（%）	76.1	51.3	26.7	32.3	15.8	<0.01

项目	2013-2014	2014-2015	2015-2016	2016-2017	2017-2018	P值
频繁检测人数（例）	4	7	14	15	40
不频繁检测人数（例）	7	12	19	27	8
总人数（例）	11	19	33	42	48
频繁检测比例（%）	36.4	36.8	42.4	35.7	83.3	<0.05

终点事件	每100人年事件（事件数）			校正前		校正后
终点事件	不频繁检测组		频繁检测组	HR（95% CI）	P	HR（95% CI）	P
全因死亡	2.15（7）	0（0）
缺血性卒中	1.89（6）	0.33（1）		5.39（0.64~45.18）	0.12	6.02（0.70~52.63）	0.10
大出血	0.92（3）	0.66（2）		1.45（0.24~8.75）	0.69	1.71（0.28~10.63）	0.56

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