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Correspondence |

Antithrombotic and Thrombolytic Therapy for Valvular DiseaseDoes Antithrombosis Guideline Apply to Chinese?: Can This Guideline Apply to Chinese? FREE TO VIEW

Bo Fu, MD; Huaidong Chen, MD; Li Dong, MD
Author and Funding Information

From the Department of Cardiac Surgery, West China Hospital, Sichuan University.All authors contributed equally to this work.

Correspondence to: Li Dong, MD, Department of Cardiac Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, 610041, China; e-mail: donglikn199@163.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1513-1514. doi:10.1378/chest.12-3077
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Published online
To the Editor:

We were pleased to read the article by Whitlock et al1 in the February 2012 supplement issue of CHEST. They concluded, “In patients with a mechanical mitral valve (both the aortic and mitral position), we suggest [vitamin K antagonist] therapy with a target [international normalized ratio (INR)] of 3.0 (range, 2.5-3.5).”1 However, we have several concerns about their conclusion.

First, thromboembolism and bleeding while receiving anticoagulants continues to account for 75% of all complications following mechanical heart valve replacement.2 A significant trend toward a higher frequency of thromboembolism events was observed in the group of non-Chinese patients in Western countries, while the trend in Chinese patients was a higher frequency of bleeding. Hence, there was always doubt as to whether the guideline was appropriate for Chinese patients. This high-intensity strategy is relatively more effective for races other than Chinese. INR levels between 1.5 and 2.0 are recommended for Chinese patients with anticoagulation treatment after mechanical heart valve replacement.3

Second, West China Hospital, in Chengdu, has developed a national, multicenter database (Anticoagulation Therapy Database of Chinese Patients After Heart Valve Replacement, unpublished data, January 2011-December 2012) of patients who have undergone heart valve replacement since 2011. The database is part of the Low-intensity Anticoagulation Study. The database is now one of the largest of its kind in China, with 45 centers from 15 provinces participating in the project. To date, detailed information has been collected from >8,000 patients. The preliminary research demonstrates that when INR values are between 1.5 and 2.0, the incidence of both thromboembolic and bleeding complications is the lowest.

Patients in the study need rigorous follow-up. We embarked on this study to establish an anticoagulant guideline that is in accordance with the characteristics of Chinese following heart valve replacement, as well as to provide a potential clinical research tool for the future.

References

Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and thrombolytic therapy for valvular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e576S-e600S. [CrossRef] [PubMed]
 
Koertke H, Minami K, Boethig D, et al. INR self-management permits lower anticoagulation levels after mechanical heart valve replacement. Circulation. 2003;108(suppl 1):1175-1178. [CrossRef]
 
Dong L, Shi YK, Tian ZP, Ma JY, Wang X, Yi J. Low intensity anticoagulation therapy after mechanical heart valve replacement [in Chinese]. Zhonghua Wai Ke Za Zhi. 2003;41(4):250-252. [PubMed]
 

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References

Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and thrombolytic therapy for valvular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e576S-e600S. [CrossRef] [PubMed]
 
Koertke H, Minami K, Boethig D, et al. INR self-management permits lower anticoagulation levels after mechanical heart valve replacement. Circulation. 2003;108(suppl 1):1175-1178. [CrossRef]
 
Dong L, Shi YK, Tian ZP, Ma JY, Wang X, Yi J. Low intensity anticoagulation therapy after mechanical heart valve replacement [in Chinese]. Zhonghua Wai Ke Za Zhi. 2003;41(4):250-252. [PubMed]
 
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