Letter:
Dear Editor,
We read the research by Lucas C. Godoy MD et al., ”Association between
time to therapeutic INR and length of stay following mechanical heart
valve surgery” with considerable interest.1 Reading
this article was fortuitous, and the author’s efforts are to be praised.
We concur with the most important element that achieving a therapeutic
INR early in the postoperative period of mechanical valve surgery is
inextricably linked to a shorter length of stay. However, we feel it is
essential to mention a few additional points that would improve this
work’s effectiveness and add to prior knowledge.
Considering the limitations of this study, only a small number of people
were included in the study, which may have influenced the results. For
illustration, Christopher J.Arendt et al.2 enrolled
twice as many patients in a 2017 study to obtain significant results by
raising the study’s power. Similarly, specific statistics pertaining to
the patient’s baseline characteristics and variables were not bestowed.
However, in the identical study, detailed description history regarding
the use of inotropes, intra-aortic balloon pump, congestive heart
failure (CHF), chronic obstructive pulmonary diseases (COPD), New York
Heart Association classification, and dialysis percentile were
designated.2 Third, the authors did not provide
detailed postoperative comparative anticoagulation data, which could
have influenced the study’s outcome. For example, a study by John
Fanikos et al.3 shed light on the following topics:
time from surgery to initiation of parenteral anticoagulation, mean
duration of parenteral anticoagulation, mean total daily dose, time from
surgery to first warfarin dose, mean initial warfarin dose, mean daily
warfarin dose, the number of warfarin doses before hospital discharge,
mean length of stay, and range in length of stay.
To summarize, warfarin dosing is a potentially hazardous procedure,
especially in hospitalized patients. Hospitalization could be an event
that identifies patients with poor anticoagulation control and targets
them for anticoagulation interventions. If anticoagulation control is
poor prior to hospitalization, a different strategy is required. It’s
possible that the differences in length of stay are due to different
admissions and bleeding treatment during oral anticoagulation.