Sex‐based difference in anticoagulated patients with mechanical prosthetic heart valves and long‐term mortality risk. Issue 5 (11th February 2021)

• Record Type: Journal Article
• Authors: Pastori, Daniele; Poli, Daniela; Antonucci, Emilia; Menichelli, Danilo; Violi, Francesco; Palareti, Gualtiero; Pignatelli, Pasquale
• Other Names: Testa Sophie investigator.; Paoletti Oriana investigator.; Lodigiani Corrado investigator.; Ferrazzi Paola investigator.; Quaglia Ilaria investigator.; Coffetti Nadia investigator.; Marotta Rosa investigator.; Brusegan Varusca investigator.; Bergamelli Orazio investigator.; Lombardo Alzano investigator.; Facchinetti Roberto investigator.; Serricchio Giuseppina investigator.; Sarpau Silvia investigator.; Brevi Francesca investigator.; Como Lariana investigator.; Falco Pietro investigator.; Silverio Guarino investigator.; Mangione Catello investigator.; Bellomo Giacomo investigator.; Masottini Serena investigator.; Cosenza Alessandra investigator.; Ruocco Lucia investigator.; Chiarugi Paolo investigator.; Casini Monica investigator.; Cafolla Arturo investigator.; Ferretti Antonietta investigator.; Micucci Giorgia investigator.; Rupoli Serena investigator.; Canafoglia Lucia investigator.; Pedico Paolo investigator.; Galasso Rita investigator.; Rotunno Rosa investigator.; Dimiccoli Barletta Raffaele investigator.; Insana Antonio investigator.; Valesella Paolo investigator.; Santoro Angelo investigator.; Marongiu Francesco investigator.; Barcellona Doris investigator.; Pengo Vittorio investigator.; Denas Gentian investigator.; Paparo Carmelo investigator.; Bucherini Eugenio investigator.; Tani Flavia investigator.; Carioli Enrico investigator.; Vicario Tommasa investigator.; Saliola Mirella investigator.; Masciocco Lucilla investigator.; Saracino Pasquale investigator.; Benvenuto Angelo investigator.; Turrini Anna investigator.; Ciaffone Stefano investigator.; Toma Andrea investigator.; Barbera Pietro investigator.; Gresele Paolo investigator.; Fierro Tiziana investigator.; Pasquino Stefano investigator.; Rosa Lucia La investigator.; Morales Rino investigator.; Ronchi Francesco investigator.; Isu Giuseppe investigator.; Lerede Teresa investigator.; Barcella Luca investigator.; Crisantemo Rosanna investigator.; Suriano Luciano investigator.; Lorusso Luciano investigator.; Sarlo Mario investigator.; Carrato Pasquale investigator.; Oricchio Carmine investigator.; Grandone Elvira investigator.; Colaizzo Donatella investigator.; Molinatti Maurizio investigator.;
• Is Part Of: International journal of clinical practice. Volume 75:Issue 5(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-02-11
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.14064
• Languages: English
• ISSNs: 1368-5031

Abstract

Abstract: Background: Vitamin K antagonists (VKAs) reduce thromboembolism in patients with mechanical prosthetic heart valves (MPHV). It is unclear whether a sex‐based difference in MPHV patients regarding valve site, anticoagulation quality, and mortality risk does exist. Methods: We analysed 2111 MPHV patients from the nationwide PLECTRUM study promoted by the Italian Federation of Anticoagulation Clinics (FCSA). We analysed the site of MPHV, anticoagulation quality, as assessed by the time in therapeutic range (TiTR), and mortality risk in women and men. Results: The mean age of the patients was 56.8 ± 12.3 years. Women were older with a lower prevalence of ischemic heart disease and smoking habit and a higher prevalence of atrial fibrillation at baseline. Aortic MPHV was more frequent in men (74.7% vs 43.3%, P < .001), whereas mitral (41.1% vs 17.6%, P < .001) and mitro‐aortic (15.6% vs 7.7%, P < .001) MPVH in women. The association between female sex and mitral/mitro‐aortic site remained at multivariable logistic regression analysis (Odds Ratio 3.623, 95% Confidence Interval [CI] 2.947‐4.455, P < .001). Regarding anticoagulation quality, women showed lower mean TiTR (63.0 ± 19.4 vs 57.5 ± 19.2, P < .001), and a higher proportion of TiTR < 60% (54.9% vs 43.3%, P < .001). During a mean follow‐up of 123 months (21 665 pt‐years), 152 deaths occurred (0.7%/year); 83 in the aortic (0.63%/year) and 69 in the mitral/mitro‐aortic (0.81%/year) group. At multivariable Cox proportional hazard regression analysis, female sex was not associated with mortality (HR 0.953, 95%CI 0.678 1.340, P = .783). Conclusions: Female sex is independently associated with mitral/mitro‐aortic MPHV. Despite a lower TiTR in women, mortality risk did not differ between the two groups.