title: Is low anticoagulation intensity more beneficial for patients with bileaflet mechanical mitral valves? a meta-analysis.
abstract: OBJECTIVE
  For the mitral valve replacement(MVR) patients using the lowest thrombogenic risk bileaflet valves (St. Jude Medical, Carbomedics and On-X Prosthetic Heart Valve), excellent results can be achieved by adopting the anticoagulation intensity(median INR<2.5)which is lower than the recommended intensity(INR:2.5~3.5). Our aim was to provide a pooled estimate of potential benefit from clinical studies using low anticoagulation intensity and high intensity in these patients.
  
  
  METHODS
  Relevant studies published before Feb. 2014 were searched through a number of digital databases(MEDLINE, EMBASE, Cochrane Library, etc.). They were pooled by SPSS19.0 using the random effect method in three fields: occurrence rate of major thromboembolism, major hemorrhage and major total events.
  
  
  RESULTS
  14 studies with 3595 patients were included. The follow-up period was 12846.6 patient*year. Pooled estimates indicated reduction in major hemorrhage (RR: 0.420, 95%CI: 0.296~0.595, P<0.001) and major total events(RR: 0.738, 95%CI: 0.604~0.902, P=0.003) in the low intensity group. No difference was noted in major thromboembolism(RR: 1.045, 95%CI: 0.814~1.341, P=0.75).
  
  
  CONCLUSIONS
  Compared with the recommended high intensity, low anticoagulation intensity (median INR<2.5) may be more beneficial for the MVR patients using the lowest thrombogenic risk bileaflet valves. We recommended an INR between 2.0 and 2.5, with a median INR of 2.3 for these MVR patients.
authors.affiliation: . Division of Cardiac Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R.China - himybox@126.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Xu
authors.forename: Z P
authors.initials: ZP
authors.lastname: Wang
authors.forename: J S
authors.initials: JS
authors.lastname: Ou
authors.forename: S L
authors.initials: SL
authors.lastname: Yin
authors.forename: L J
authors.initials: LJ
authors.lastname: Liu
authors.forename: X
authors.initials: X
authors.lastname: Zhang