Comparison of Warfarin Initiation at 3 mg Versus 5 mg for Anticoagulation of Patients with Mechanical Mitral Valve Replacement Surgery: A Prospective Randomized Trial

Sarah Sabry, Lamia Mohamed El Wakeel, Ayman Saleh, Marwa Adel Ahmed, Sarah Sabry, Lamia Mohamed El Wakeel, Ayman Saleh, Marwa Adel Ahmed

Abstract

Background: The increased warfarin sensitivity observed after mechanical mitral valve replacement (MVR) operations dictates clinical discretion in warfarin dose initiation. Evidence is still lacking with regard to anticoagulation management of MVR patients.

Objective: This study aimed to compare initiating warfarin at the recommended dosing regimen versus empirically lowered doses intended to account for the variation in warfarin sensitivity.

Methods: A prospective, single-blind, randomized, comparative study was conducted in postoperative MVR patients. Patients were randomly assigned to either the 5 mg group (n = 25) or the 3 mg group (n = 25) and were initiated on a 5 or 3 mg warfarin dose, respectively. Time to target international normalized ratio (INR), time in therapeutic range, occurrence of bleeding/thromboembolic events, and cost of bridging with enoxaparin were assessed for both groups.

Results: Target INR was achieved earlier in the 5 mg group than in the 3 mg group (p = 0.033), with a mean ± SD of 5.3 ± 2.0 and 6.6 ± 2.0, respectively (95% confidence interval of the mean difference 1.022-1.890). Bleeding events did not differ significantly between the two groups. The cost of enoxaparin consumption per patient was significantly higher in the 3 mg group versus the 5 mg group (p = 0.002).

Conclusions: The initiation of warfarin at a 5 mg dose in MVR patients was more efficacious than the 3 mg dose in terms of time to reach the target INR. Moreover, the cost of enoxaparin bridging was significantly reduced with a 5 mg warfarin initiation dose. Bleeding events were comparable.

Gov id: NCT04235569, 22 January 2020.

Conflict of interest statement

Sarah Sabry, Lamia Mohamed El Wakeel, Ayman Saleh, and Marwa Adel Ahmed have no conflicts of interest to declare that are relevant to the contents of this article. All authors certify that they are not involved in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow diagram: enrollment, randomization, and follow-up
Fig. 2
Fig. 2
Dot plot showing individual TRT for the 25 patients in each group. TRT time to reach therapeutic international normalized ratio

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