TIME IN THERAPEUTIC RANGE (TTR) PROFILE IN PATIENTS ON VITAMIN K ANTAGONISTS POST HEART VALVE REPLACEMENT SURGERIES

Dr Sankalp Sharma; Dr Mohmad Iqbal Wani; Dr Sajad Sumji

Volume : IX, Issue : VI, June - 2020

TIME IN THERAPEUTIC RANGE (TTR) PROFILE IN PATIENTS ON VITAMIN K ANTAGONISTS POST HEART VALVE REPLACEMENT SURGERIES

Dr Sankalp Sharma, Dr Mohmad Iqbal Wani, Dr Sajad Sumji

Abstract :

INTRODUCTION: Oral anticoagulants have an important role in the long term anticoagulation following prosthetic valve replacement surgeries. The patients with mechanical prosthetic valves are at an increased risk of valve thrombosis and embolism. Anticoagulation usually started soon after mechanical valve replacement procedures as the risk of valvular thrombosis is high during the first 3 months after surgery. TYPE OF STUDY: Prospective Hospital based study OBJECTIVES: To calculate the Time in Therapeutic Range (TTR) in patients receiving VKA following prosthetic valve replacement surgeries. MATERIAL AND METHOD: 100 patients from 1st march 2016 onwards who had valve replacement surgery and were put on Vitamin K antagonists were studied in this prospective study. Only those patients who had mechanical valves were included in this study. RESULTS: The majority of the subjects were beyond 40 years of age. There was an equal gender distribution with majority of valve replacement for mitral position followed by aortic valve. The warfarin prescription rate was significantly higher in our study, possibly related to the practice pattern of the prescribing physicians (Warfarin in 80% vs. Acenocumarol in 20%). The 63% in our study group achieved a TTR >60%. The TTR levels did not differ with the different age groups of patients (p= 0.690) and the gender (p = 0.718).The TTR also didn�t significantly differ in subjects with mitral vs. aortic position (mean TTR 53.77 � 13.33 vs. 53.85 � 13.88), however the patients with DVR had significantly lower levels of TTR (47.5 � 15). CONCLUSION: Time in therapeutic range (TTR) is an excellent prognostic marker of the quality of anticoagulation treatment with vitamin K antagonists.