Valvular & structural heart disease
Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study
Authors' conclusion
Adverse events, particularly major bleeding, are common in patients with AF following mechanical AVR, and mortality is high. Suboptimal TTR appears to predict bleeding episodes, ischaemic stroke, and death, and it could be useful in high-risk patient identification and targeting of preventive strategies.
Study context
- Population
- Patients diagnosed with atrial fibrillation (AF) during 2007–18 in Finland undergoing mechanical aortic valve replacement (AVR) before or after the AF diagnosispatients with mechanical AVR and AF either before (41.2%) or after (58.8%) the operation
- Participants
- 1,086 patients
- Exposure
- Quality of vitamin K antagonist (VKA) therapy (time in therapeutic range (TTR)) and bleeding and ischaemic events following mechanical AVR
- Outcome
- Cumulative incidence of adverse events
- Follow-up
- 10 years after AVR
Main finding
As reported in the abstract
Significant bleeding
27.9%
Intracranial haemorrhage
5.8%
Ischaemic stroke
12.8%
Myocardial infarction
7.2%
Observational data: associations, not effects.
Further findings
Bleeding occurrence
| aHR (CI) | P value | ||
|---|---|---|---|
| TTR < 80% with INR target 2.0-3.5Higher bleeding occurrence with TTR < 80% | 1.97 (1.39–2.79) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Stroke occurrence
| aHR/standard deviation (CI) | P value | ||
|---|---|---|---|
| TTR with INR target ≥2.0Associated with higher stroke occurrence | 1.22 (1.01–1.46) | P = 0.035 | |
| 0.512AHR/standard deviation (log scale) |
Mortality · 10 years
| aHR (CI) | P value | ||
|---|---|---|---|
| TTR <80%Higher mortality with TTR <80% | 2.74 (2.00–3.76) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Mortality — Mortality
- 28.9%/10 years
Original publication
Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study. Eur Heart J Qual Care Clin Outcomes. Published 14 May 2025. doi:10.
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