Oral anticoagulant management of patients with mechanical heart valves at the Salam Centre of Khartoum: Observations on quality of anticoagulation and thrombotic risk.


Erba, Nicoletta, Tosetto, Alberto, Langer, Martin, Abdallah, Suha Abdelwahab, Giovanella, Elena, Lentini, Salvatore ORCID: 0000-0001-5340-2589, Masini, Franco, Mocini, Alessandro, Portella, Gennarina, Salvati, Alessandro Cristian et al (show 4 more authors) (2022) Oral anticoagulant management of patients with mechanical heart valves at the Salam Centre of Khartoum: Observations on quality of anticoagulation and thrombotic risk. Thrombosis research, 219. pp. 155-161.

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Abstract

<h4>Introduction</h4>Rheumatic heart disease with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires long-life anticoagulation and managing this can be challenging.<h4>Methods and results</h4>We report data of a prospective observational study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum, by Emergency, an Italian Non-Governmental Organization, to evaluate the quality of anticoagulation control and the risk of thrombotic complications.<h4>Results</h4>We studied 3647 patients (median age 25.1 years; 53.9 % female). Median Time in Therapeutic Range (TTR) was 53 % (interquartile range 37 % to 67 %) and 70 thrombotic events (rate 1.8 × 100 pt-years [95 % CI 1.38-2.23]) were recorded. Among patients in the first quartile of TTR (≤37 %), we recorded 34/70 (48.6 %) of all thrombotic events (rate 3.7 × 100 pt-years [95 % CI 2.5-5.1]), with a high mortality rate (2.2 × 100 pt-years [95 % CI 1.3-3.3]). In patients with guideline-recommended TTR (≥65 %) the event rate was 0.8 × 100 pt-years for thrombotic events [95 % CI 0.3-1.5] and 0.4 × 100 pt-years for mortality [95 % CI 0.1-0.9]. Multivariable analysis showed that having a TTR in the lowest quartile (≤37 %) and being noncompliant are significantly associated with increased thrombotic risk. Aspirin use or different valve type did not influence the thrombotic risk. Almost 40 % of all thromboembolic complications could have been potentially prevented by further improving VKA management to obtain a TTR > 37 %.<h4>Conclusion</h4>The thrombotic risk of MHV patients on VKAs living in a low-income country like Sudan is associated with low quality of anticoagulation control. Efforts should be made to decrease the number of non-compliant patients and to reach a guideline-recommended TTR of ≥65 %.

Item Type: Article
Uncontrolled Keywords: Heart Valves, Humans, Thrombosis, Hemorrhage, Aspirin, Anticoagulants, Blood Coagulation, Adult, Female, Male
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 17 Oct 2023 13:55
Last Modified: 17 Oct 2023 13:55
DOI: 10.1016/j.thromres.2022.09.018
Open Access URL: https://doi.org/10.1016/j.thromres.2022.09.018
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3173821
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