Abstract
Quality of warfarin therapy in patients with a mechanical prosthetic heart valve (MPHV) has been barely investigated. We analysed determinants of low time in the therapeutic range (TiTR <60%) in 2111 patients with MPHVs from the nationwide PLECTRUM study by the Italian Federation of Anticoagulation Clinics. Overall, 48·5% of patients had a TiTR of <60%. At logistic regression analysis, arterial hypertension (odds ratio [OR] 1·502, P<0·001), diabetes (OR 1·732, P<0·001), heart failure (OR 1·484, P=0·004), mitral site (vs. aortic) (OR 1·399, P=0·006), international normalised ratio (INR) ranges of 2·5-3·5 (OR 2·575, P<0·001) and 3·0-4·0 (OR 8·215, P<0·001) associated with TiTR <60%. TiTR is substantially suboptimal in MPHV patients, particularly in higher INR ranges.
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