Warfarin Compliance after Mechanical AVR in the Pediatric Population: Case Series from a Developing Country
Open Access
- 1 January 2022
- journal article
- research article
- Published by Scientific Research Publishing, Inc. in World Journal of Cardiovascular Surgery
- Vol. 12 (08), 184-190
- https://doi.org/10.4236/wjcs.2022.128014
Abstract
Background and Aim: Mechanical prosthetic heart valves exert a lifelong thromboembolic complication requiring continuous antithrombotic therapy. Vitamin K antagonist is the recommended therapy of choice along with meticulous INR monitoring to achieve and maintain an INR of 2.0 - 3.0. The study aimed to assess the compliance of anticoagulant therapy in pediatric patients after AVR and to highlight the challenges faced during follow-ups. Methods: A retrospective study was conducted at NICVD Hospital in Karachi, Pakistan for a time frame of 2 years from 2020-2021 where 7 patients were selected. Data were collected using hospital medical records and then validated through a phone call mediated structured questionnaire-based interview. Results: 2 out of 7 patients in the case series were compliant to regular follow-ups and had their INR in the desired range owing to their higher education status and access to INR clinic for regular follow-up in urban setting. Younger patients in the case series were non-compliant. 4 out of 7 patients who were on dual anti-coagulant regimens including warfarin and aspirin were either closer or within the range than compared to those on single drug regimen. Conclusion: Compliance was observed in patients who had favorable demographics and higher education. Multiple recent trials including PROACT and PROACT XA are underway to develop novel treatment options apart from warfarin after mechanical aortic valve replacement. Home-based INR testing kits provide easy access to regular testing in remote areas. Multi-center studies are required for in-depth analysis regarding reasons of non-compliance in pediatric population.Keywords
This publication has 11 references indexed in Scilit:
- Rationale and design of PROACT Xa: A randomized, multicenter, open-label, clinical trial to evaluate the efficacy and safety of apixaban versus warfarin in patients with a mechanical On-X Aortic Heart ValveAmerican Heart Journal, 2020
- Management of thrombosis in children and neonates: practical use of anticoagulants in childrenHematology, 2018
- Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart diseaseThe Journal of Thoracic and Cardiovascular Surgery, 2018
- Anticoagulation and Antiplatelet Strategies After On-X Mechanical Aortic Valve ReplacementJournal of Invasive Cardiology, 2018
- Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015The New England Journal of Medicine, 2017
- Safety and Use of Anticoagulation After Aortic Valve Replacement With BioprosthesesCirculation: Cardiovascular Quality and Outcomes, 2016
- A Meta-Analysis of Randomized Controlled Trials of the Risk of Bleeding With Apixaban Versus Vitamin K AntagonistsThe American Journal of Cardiology, 2014
- Antithrombotic and Thrombolytic Therapy for Valvular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Apixaban for Reduction In Stroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial: Design and rationaleAmerican Heart Journal, 2010
- Antiplatelet and anticoagulation for patients with prosthetic heart valvesPublished by Wiley ,2003