New study on lower therapeutic INR target levels

[Lionheart]

Reduced anticoagulation seen safe for aortic valve replacement patients
http://www.thedoctorschannel.com/video/3520.html?specialty=31

The link has a summary of a recent, small study that showed that an INR target lower than the current recommendation reduced the risk of bleeding events without increasing the risk of clots for low-risk mechanical AVR patients.

Details:
They had 2 groups of about 200 people each with mechanical AVR.
Group-A had a lower INR target of 1.5-2.5
Group-B had the current recommended INR target of 2.0-3.0

After 5.6 years:
They found that Group-A had fewer hemorrhagic (bleeding) events (6 vs 16) and no increase in thromboembolic (clotting) events (1 vs 3) compared to Group-B. Of course thromboembolism is what anticoagulation is trying to prevent and statistically there was no strong difference in rates of thromboembolism between the two groups.

The study was published in the American Heart Journal for July, 2010 and summarized on The Doctor Channel in the link above.

Best,
John

 

[Ross]

Got to love things like this. They leave out needed data. I'm willing to bet the higher INR range group, and most likely the lower for that matter, had some sort of management issues. Nearly every, but not all, just most events, can be tied to poor patient management or compliance issues.

 

[AgilityDog]

Yes, and I'll bet they didn't distinguish between who had a St Jude's or other valve, and who had and On-x valve. They need to compare apples to apples.

 

[olefin]

Interesting info.

But maybe they should do a study on how many medial professionals know how to manage warfarin.

I'll stay with my personal "study", 2.5 to 3.5 that has over 19 years backing it.

 

[dick0236]

Reduced anticoagulation seen safe for aortic valve replacement patients
http://www.thedoctorschannel.com/video/3520.html?specialty=31

The link has a summary of a recent, small study that showed that an INR target lower than the current recommendation reduced the risk of bleeding events without increasing the risk of clots for low-risk mechanical AVR patients........

........ Of course thromboembolism is what anticoagulation is trying to prevent and statistically there was no strong difference in rates of thromboembolism between the two groups.
John

After 4+ decades on warfarin, I have had NO bleeding events whatsoever....but I have had ONE "thromboembolic" event (stroke due to INR under 1.5) that was life altering. The quoted statement "Of course thromboembolism is what anticoagulation is TRYING to prevent and statistically there was NO strong differences in rates of thromboembolism between the two groups." kinda says it all. I like the saying around here...it is more important to lessen the risk of destroyed brain cells rather than the loss of a few blood cells. I think I'll stay in the 2.5-3.5 range since I know it works:wink2:.

 

[Cris N]

My question is... who would agree to be part of that study (other than, perhaps, On-X valve)?

 

[Luana]

But maybe they should do a study on how many medial professionals know how to manage warfarin.

ROTF. Yes.
I don't know but 1.5 - 2.5 as a target range makes me a little nervous. Isn't the high end of INR for a normal person around 1.2? Are you really getting any benefits at the low end of that range?