{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:07:51Z","timestamp":1781586471978,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the optimal anticoagulation intensity of warfarin in a South\u2010East Asian population with moderate\u2010to\u2010severe rheumatic mitral stenosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicentre, retrospective study examined patients with rheumatic mitral stenosis who had not undergone valve replacement or repair and required long\u2010term warfarin therapy at two hospitals in Thailand from 2013 to 2018. The main outcomes were thromboembolism and major bleeding. Incidence rate ratios for these events at each level of anticoagulation intensity (international normalized ratio [INR]) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 933 patients with 3538 patient\u2010years of follow\u2010up, a mean follow\u2010up of 3.8\u00a0years and 23\u2009700 INR values. Mean age was 56.1\u2009\u00b1\u200911.8\u00a0years. During follow\u2010up, there were 149 thromboembolic events (4.2 per 100 patient\u2010years) and 132 major bleeding events (3.7 per 100 patient\u2010years). Net adverse clinical events were lowest at INR 2.50\u20102.99, with no significant difference between INR 2.00\u20102.49 and 3.00\u20103.50. Standard INR (2.0\u20103.0) and high\u2010intensity INR (2.5\u20103.5) had comparable net adverse clinical event rates (incidence rate ratio 0.99, 95% confidence interval [CI] 0.66\u20101.54, <jats:italic>P<\/jats:italic>\u2009=\u2009.99). However, thromboembolism incidence was higher with standard INR (incidence rate ratio 2.49, 95% CI 1.13\u20106.23, <jats:italic>P<\/jats:italic>\u2009=\u2009.013), while major bleeding was lower (incidence rate ratio 0.57, 95% CI 0.35\u20100.98, <jats:italic>P<\/jats:italic>\u2009=\u2009.045). No significant difference in intracranial haemorrhage rates was observed between the two INR intensities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The standard anticoagulation intensity is an optimal range for Asian population with moderate\u2010to\u2010severe rheumatic mitral stenosis. High intensity anticoagulation (INR of 2.50\u20103.50) further reduces thromboembolism but increases major bleeding but not intracranial haemorrhage.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bcp.70034","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T23:44:24Z","timestamp":1741736664000},"page":"2273-2282","source":"Crossref","is-referenced-by-count":2,"title":["Anticoagulation intensity and outcomes among southeast\u2010Asians with moderate\u2010to\u2010severe mitral valve stenosis"],"prefix":"10.1002","volume":"91","author":[{"given":"Punyawee","family":"Puchsaka","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Faculty of Pharmacy Mahidol University  Bangkok Thailand"},{"name":"Faculty of Pharmacy Siam University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8220-3490","authenticated-orcid":false,"given":"Wipharak","family":"Rattanavipanon","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Faculty of Pharmacy Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sararat","family":"Phetroong","sequence":"additional","affiliation":[{"name":"Buriram Hospital, Muang District  Buriram Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudeekorn","family":"Ue\u2010sethasakdhi","sequence":"additional","affiliation":[{"name":"Buriram Hospital, Muang District  Buriram Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suparat","family":"Wattanasombat","sequence":"additional","affiliation":[{"name":"Chiangrai Prachanukroh Hospital, Mueang District  Chiang Rai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wattana","family":"Wongtheptien","sequence":"additional","affiliation":[{"name":"Chiangrai Prachanukroh Hospital, Mueang District  Chiang Rai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4828-4412","authenticated-orcid":false,"given":"Surakit","family":"Nathisuwan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Faculty of Pharmacy Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezab389"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005451"},{"key":"e_1_2_11_5_1","first-page":"e72","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto CM","year":"2021","journal-title":"Circulation"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.12.014"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2209051"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000001013"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_2_11_12_1","first-page":"1129","volume-title":"Distribution of thromboembolism in valvular versus non\u2010valvular atrial fibrillation","author":"Blustin JM","year":"2014"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101613584"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-14-1057"},{"key":"e_1_2_11_15_1","first-page":"904","article-title":"Optimal INR to prevent stroke in Thai patients with rheumatic mitral stenosis and atrial fibrillation who are receiving warfarin","volume":"102","author":"Kaewkanlaya R","year":"2019","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.01.098"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0897190019894142"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.4070\/kcj.2020.0098"},{"key":"e_1_2_11_19_1","unstructured":"Ministry of Public Health.Warfarin registry network of Thailand. Updated June 28 2022. Accessed July 1 2023.http:\/\/thaiacc.org\/warfarin\/"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000086801"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199507063330103"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1651587"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2014.07.013"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13140"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-128-11-199806010-00001"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.32.1.26"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.066477"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15540"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061698"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2090"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.03.022"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-13-0885"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70034","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T07:14:56Z","timestamp":1753773296000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/bcp.70034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/bcp.70034"],"URL":"https:\/\/doi.org\/10.1002\/bcp.70034","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]}}}