Treatment Stability of Warfarin and Acenocoumarol in Patients With MechanicalHeart Valves and Atrial Fibrillation: A One-Year Cohort Study
DOI:
https://doi.org/10.5644/ama2006-124.497Keywords:
Mechanical Heart Valves, Atrial Fibrillation, Warfarin, Acenocoumarol, INR, Treatment StabilityAbstract
This study aimed to investigate which of the two vitamin K antagonists, warfarin or acenocoumarol, provides more stable anticoagulation control in patients with mechanical heart valves and atrial fibrillation.
Patients and Methods. This was a
prospective, one-year clinical cohort study. In total, 73 outpatients with mechanical heart valves and atrial fibrillation who were already treated with warfarin or acenocoumarol were recruited from the Blood Transfusion Institute of the Federation of Bosnia and Herzegovina. The prothrombin time target values, expressed as the international normalized ratio (INR), were 2.0–3.0/4.0. Numerical data between the treatment groups were summarized descriptively.
Results. Patients in the warfarin (N=35) and acenocoumarol (N=38) treatment groups were similar in terms of sex, age, body mass index, body surface area, and number of concomitant drugs known to interact with vitamin K antagonists. The number of INR measurements per patient, number of INR measurements within the therapeutic range per patient, mean time interval between successive INR measurements, and mean INR values across consecutive measurements were similar in both groups. However, compared to acenocoumarol, warfarin treatment seemed to be associated with more stable anticoagulation, i.e., with a higher mean time in the therapeutic range (TTR) (76.1±24.2 vs. 69.1±21.5%) and a smaller proportion of patients below all predefined TTR thresholds (<60%, <65%, and <70%).
Conclusion. Our unadjusted descriptive results suggested that warfarin, compared to acenocoumarol, may provide more stable and therefore safer anticoagulation control in patients with mechanical heart valves and atrial fibrillation. To confirm this, larger prospective clinical studies are needed in patients with mechanical heart valves with or without atrial fibrillation.
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