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    Investigation of Left Atrial Spontaneous Echo Contrast as a Marker Indicating Ineffective Anticoagulation in Patients with Mitral Valve Replacement Receiving Warfarin
    (2019) Gunturk, Ertugrul Emre; Demirbas, Melih; Dogan, Yasemin; Dogan, Selcuk; Gunturk, Inayet
    Objectives: This study aimed to evaluate predictive role of left atrial (LA) spontaneous echo contrast (SEC) for ineffec-tive anticoagulation by assessing time in therapeutic range (TTR) via international normalized ratio (INR) monitoring in patients with mitral valve replacement (MVR) and to determine its relationship with increased thromboembolic events.Methods: The study included patients with mechanical MVR. TTR was estimated using serial INR measurements. On transthoracic echocardiography, left ventricular end-systolic/end-diastolic diameters, LA diameter, ejection fraction were measured, and the presence of SEC was determined.Results: The study included 65 patients with MVR (30 with LA SEC) and 35 without LA SEC. There was a trend for higher rates of cerebrovascular event in the patients with SEC than in those without (30% vs. 14.3%, p=0.046). The LA diameter was higher and the TTR was lower in the patients with SEC than in those without. There was a significant negative cor-relation between TTR and thromboembolic events. Multivariable logistic regression analysis revealed the TTR and LA diameter as independent factors affecting SEC.Conclusion: In patients with MVR, low TTR and enlarged left atrium were independent predictors for future throm-boembolic events. Monitoring INR is important to achieve higher TTR in the presence of LA SEC.