Evidence map›Paper›PMID 40366898›Full record

ArticleEuropean heart journal. Quality of care & clinical outcomes2025

Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study.

Joonas Lehto, Rikhard Björn, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Juhani K E Airaksinen and 2 more

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal. Quality of care & clinical outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04645537 (Finnish AntiCoagulation in Atrial Fibrillation), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04645537 completednot on this map

Finnish AntiCoagulation in Atrial Fibrillation (FinACAF)

TypeobservationalSponsorHelsinki University Central HospitalRan2011 to 2018Enrolled400,000ConditionsAtrial Fibrillation
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Joonas LehtoHeart Center, Turku University Hospital and University of Turku, POB 52, Turku FI-20521, Finland.ORCID 0000-0002-6420-8607
Rikhard BjörnHeart Center, Turku University Hospital and University of Turku, POB 52, Turku FI-20521, Finland.
Olli HalminenDepartment of Industrial Engineering and Management, Aalto University, Espoo, Finland.
Miika LinnaDepartment of Industrial Engineering and Management, Aalto University, Espoo, Finland.
Jari HaukkaFaculty of Medicine, University of Helsinki, Helsinki, Finland.ORCID 0000-0003-1450-6208
Jukka PutaalaDepartment of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.ORCID 0000-0002-6630-6104
Pirjo MustonenHeart Center, Turku University Hospital and University of Turku, POB 52, Turku FI-20521, Finland.ORCID 0000-0003-1319-0248
Janne KinnunenDepartment of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Juha HartikainenHeart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
Juhani K E AiraksinenHeart Center, Turku University Hospital and University of Turku, POB 52, Turku FI-20521, Finland.
Tuomas O KiviniemiHeart Center, Turku University Hospital and University of Turku, POB 52, Turku FI-20521, Finland.
Mika LehtoFaculty of Medicine, University of Helsinki, Helsinki, Finland.ORCID 0000-0002-8691-5142

Funding

Aarne Koskelo FoundationHelsinki and Uusimaa Hospital District Research Fund TYH2019309the Finnish Foundation for Cardiovascular Research
6 · The paper itself

Abstract

aimsMechanical aortic valve replacement (AVR) remains the primary treatment for younger patients with severe aortic valve disease. However, limited information is available regarding the quality of the required lifelong vitamin K antagonist (VKA) therapy, atrial fibrillation (AF), and their relationship with adverse events after AVR. This study assessed the quality of VKA therapy prior to bleeding and ischaemic events following mechanical AVR in patients with AF. METHODS AND

resultsThe registry-based Finnish AntiCoagulation in Atrial Fibrillation study combining data from several Finnish healthcare registers covers all patients diagnosed with AF during 2007-18 in Finland. This analysis included patients undergoing mechanical AVR before or after the AF diagnosis. A total of 1086 patients with mechanical AVR and AF either before (41.2%) or after (58.8%) the operation were identified. Cumulative incidence estimates at 10 years after AVR were 27.9% for significant bleeding, 5.8% for intracranial haemorrhage, 12.8% for ischaemic stroke, and 7.2% for myocardial infarction. Time in therapeutic range (TTR) < 80% with international normalized ratio (INR) target 2.0-3.5 was associated with higher bleeding occurrence [adjusted hazard ratio (aHR) 1.97, 1.39-2.79, P < 0.001]. Time in therapeutic range with INR target ≥2.0 was associated with higher stroke occurrence (aHR/standard deviation 1.22, 1.01-1.46, P = 0.035). Mortality was high (28.9%/10 years), and TTR <80% was associated with higher mortality (aHR 2.74, 2.00-3.76, P < 0.001).

conclusionAdverse events, particularly major bleeding, are common in patients with AF following mechanical AVR, and mortality is high. Suboptimal TTR appears to predict bleeding episodes, ischaemic stroke, and death, and it could be useful in high-risk patient identification and targeting of preventive strategies.

trial registrationFinnish AntiCoagulation in Atrial Fibrillation study, ClinicalTrials Identifier: NCT04645537, https://clinicaltrials.gov/ct2/show/NCT04645537.

Indexed as

AnticoagulantsAortic ValveAtrial FibrillationHeart Valve ProsthesisHeart Valve Prosthesis ImplantationRegistriesAgedAged, 80 and overFemaleFinlandFollow-Up StudiesHumansIncidenceMaleMiddle AgedTreatment OutcomeAnticoagulantsAcute coronary syndromeAortic valve replacementAtrial fibrillationBleedingStroke

Identifiers

PMID40366898
PMCPMC12342859

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.