title: Long-term bleeding events after mechanical aortic valve replacement in patients under the age of 60.
abstract: BACKGROUND
  Although younger patients are supposed to be less susceptible to bleeding complications of mechanical aortic valve replacement (mAVR) than older patients, there is a relative paucity of data on this subject. Therefore, it remains uncertain whether younger patients are really at a lower risk of these complications than older patients.
  
  
  METHODS
  Incidence rates of bleeding events during 15 years of follow-up after mAVR were compared between 163 patients under 60 (group I), 122 patients between 60 and 65 (group II), and 145 patients over 65 (group III) years of age at operation. The target international normalised ratio (INR) was 3.0-4.0.
  
  
  RESULTS
  During 15 years of follow-up, the annual incidence rate of major bleeding events (excluding haemorrhagic stroke) was lower in the youngest as compared with the oldest group (3.0 versus 4.7 %, respectively; p = 0.030). However, the annual incidence rate of haemorrhagic stroke was as high in the youngest as in the two older groups (0.6 versus 0.7 % and 0.7 %, respectively; p = 0.928).
  
  
  CONCLUSIONS
  With a target INR of 3.0-4.0, patients under 60 years of age are at equally high risk of haemorrhagic stroke after mAVR as older patients. This finding confirms the relevance of a lower target INR as used in international guidelines.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, PO Box 2500, 3435, CM, Nieuwegein, the Netherlands, b.m.swinkels@hetnet.nl.
authors.forename: B M
authors.initials: BM
authors.lastname: Swinkels
authors.forename: B A
authors.initials: BA
authors.lastname: de Mol
authors.forename: J C
authors.initials: JC
authors.lastname: Kelder
authors.forename: F E
authors.initials: FE
authors.lastname: Vermeulen
authors.forename: J M
authors.initials: JM
authors.lastname: Ten Berg