TITLE:
Warfarin Compliance after Mechanical AVR in the Pediatric Population: Case Series from a Developing Country
AUTHORS:
Suha Zubairi, Mohammad Hassan Mirza, Mohammad Saad Iqbal, Mubashir Zareen Khan, Muneer Amanullah
KEYWORDS:
Mechanical AVR, Warfarin, INR monitoring, Anticoagulant, Thromboembolic
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.8,
August
30,
2022
ABSTRACT: Background and Aim: Mechanical prosthetic heart valves exert a
lifelong thromboembolic complication requiring continuous antithrombotic
therapy. Vitamin K antagonist is the recommended therapy of choice along with
meticulous INR monitoring to achieve and maintain an INR of 2.0 - 3.0.
The study aimed to assess the compliance of anticoagulant therapy in pediatric
patients after AVR and to highlight the challenges faced during follow-ups. Methods: A retrospective study was conducted at NICVD Hospital in Karachi,
Pakistan for a time frame of 2 years from 2020-2021 where 7 patients were
selected. Data were collected using hospital medical records and then validated through a
phone call mediated structured questionnaire-based interview. Results: 2 out of 7 patients in the case series were compliant to regular follow-ups
and had their INR in the desired range owing to their higher education status
and access to INR clinic for regular follow-up in
urban setting. Younger patients in the case series were non-compliant. 4 out of
7 patients who were on dual anti-coagulant regimens including warfarin and
aspirin were either closer or within the range than compared to those on single
drug regimen. Conclusion: Compliance was observed in patients who had
favorable demographics and higher education. Multiple recent trials including
PROACT and PROACT XA are underway to develop novel treatment options apart from
warfarin after mechanical aortic valve replacement. Home-based INR testing kits
provide easy access to regular testing in remote areas. Multi-center studies
are required for in-depth analysis regarding reasons of non-compliance in
pediatric population.