{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T06:28:14Z","timestamp":1770359294905,"version":"3.49.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20220151"],"award-info":[{"award-number":["20220151"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20220364"],"award-info":[{"award-number":["20220364"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20190570"],"award-info":[{"award-number":["20190570"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Lifelong anticoagulation therapy is mandatory in patients with mechanical heart valves. The On-X aortic valve is currently the only mechanical heart valve approved for a lower (1.5-2.0) target international normalized ratio (INR) compared to the standard INR target 2.0-3.0. There is limited evidence demonstrating clinical benefits of the On-X valve over other mechanical aortic valves. We therefore investigated the risk of bleeding and thromboembolic events in patients with the On-X aortic valve.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>This nationwide, population-based cohort study, using the target trial emulation framework, included all adults who underwent primary mechanical aortic valve replacement in Sweden 2014-2022 from the SWEDEHEART register. The rates of major bleeding and thromboembolic events were obtained from national registers. Confounding was addressed by weighting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of the 3047 patients, 656 patients (22%) received an On-X aortic valve and 2391 patients (78%) received other mechanical aortic valves. The mean age was 54 years and 23% were women. After 8 years, the weighted major bleeding cumulative incidence was 7.2% (95% CI: 4.8%-10.7%) in the On-X valve group vs 7.0% (95% CI: 5.5%-8.8%) in the other mechanical valves group, and the weighted cumulative incidence of thromboembolic events was 7.3% (95% CI: 5.3%-10.2%) in the On-X valve group vs 6.4% (95% CI: 5.0%-7.9%) in the other mechanical valves group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>We found no clinically relevant difference in major bleeding or thromboembolic events in patients with the On-X aortic valve compared to patients with other mechanical aortic valves.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf182","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T17:21:18Z","timestamp":1753809678000},"source":"Crossref","is-referenced-by-count":3,"title":["Major Bleeding and Thromboembolic Events with the On-X Mechanical Aortic Valve Prosthesis: A SWEDEHEART Study"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8604-1565","authenticated-orcid":false,"given":"Ruixin","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , 171 76 Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dismorr","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , 171 76 Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5352-5132","authenticated-orcid":false,"given":"Magnus","family":"Dal\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , 171 76 Stockholm,","place":["Sweden"]},{"name":"Department of Cardiothoracic Surgery, Karolinska University Hospital , 171 76 Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4386-1041","authenticated-orcid":false,"given":"Natalie","family":"Glaser","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , 171 76 Stockholm,","place":["Sweden"]},{"name":"Department of Cardiology , Stockholm South General Hospital , 118 83 Stockholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2707-0263","authenticated-orcid":false,"given":"Ulrik","family":"Sartipy","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , 171 76 Stockholm,","place":["Sweden"]},{"name":"Department of Cardiothoracic Surgery, Karolinska University Hospital , 171 76 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