What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation and mechanical aortic valve replacement (n=1086). Intervention: Lower mean Time in Therapeutic Range (TTR) vs. Higher mean TTR. Primary outcome: First-ever ischemic stroke (HR 1.23, 95% CI 1.03-1.49, p=0.030).

What does this research mean for the field?

In patients with atrial fibrillation and mechanical aortic valve replacement, a lower mean Time in Therapeutic Range (TTR) during Vitamin K Antagonist treatment is associated with a significantly higher risk of ischemic stroke, major bleeding, and mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the quality of vitamin K antagonist treatment and its relationship to adverse events post mechanical aortic valve replacement in atrial fibrillation patients.

July 23, 2026European Heart JournalOpen Access

Lower TTR linked to ~23% higher ischemic stroke risk in AF and mechanical AVR.

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Why the study?

Does lower Time in Therapeutic Range (TTR) during Vitamin K Antagonist treatment increase the risk of ischemic stroke, bleeding, and mortality in patients with atrial fibrillation and mechanical aortic valve replacement?

Population

1,086 patients with atrial fibrillation and mechanical aortic valve replacement, median age 62.8, 27.1%…

Comparison

Vitamin K Antagonist treatment with lower Time… vs Higher Time in Therapeutic Range (TTR)

Design

Cohort

Follow-up

10 years

Key result

Lower mean Time in Therapeutic Range was associated with a higher risk of ischemic stroke (HR 1.23; 95% CI 1.03-1.49; p=0.030) in patients with atrial fibrillation and mechanical AVR.

Authors

JLJoonas Lehto RBRikhard Björn OHOlli Halminen

Discussion

Member takes

Overview

Suboptimal TTR identifies high-risk patients for bleeding, stroke, and death after mechanical AVR with AF; leaves open whether TTR optimization reduces events.

Key Points

This study aims to evaluate the quality of vitamin K antagonist treatment and its relationship to adverse events post mechanical aortic valve replacement in atrial fibrillation patients.
Registry-based analysis from the FinACAF study covering AF patients diagnosed between 2007-2018 in Finland.
Included patients underwent mechanical aortic valve replacement before or after AF diagnosis with a focus on ischemic events and bleeding episodes.
Hazard ratios of complications post-AVR were estimated using the Fine-Gray model adjusted for bleeding and stroke risk factors.
Cumulative incidence estimates showed 12.8% for ischemic stroke and 27.9% for significant bleeding over 10 years post-AVR.
Lower mean Time in Therapeutic Range (TTR) was associated with a higher occurrence of stroke (adjusted HR 1.23, p=0.030).
Higher mortality (71.1% survival at 10 years) linked to lower TTR (adjusted HR 1.56, p<0.001).

Study Design

Type

Cohort (n=1,086)

Multicenter

Yes

Structured PICO

Population

1,086 patients with atrial fibrillation and mechanical aortic valve replacement, without prior bleeding, stroke, or MI, followed for up to 10 years.

Exposure

Vitamin K Antagonist (VKA) treatment with lower Time in Therapeutic Range (TTR)

Comparator

Higher Time in Therapeutic Range (TTR)

Outcome

First-ever ischemic stroke, any bleeding, intracranial bleeding, and myocardial infarction (MI) after AVRhard clinical

Main Result

Hazard Ratio: 1.23 (95% CI 1.03–1.49)

p-value: p=0.030

In patients with atrial fibrillation and mechanical aortic valve replacement, suboptimal time in therapeutic range on vitamin K antagonists is associated with increased risks of ischemic stroke, bleeding, and mortality.

Cite This Study

Lehto et al. (2023) conducted a cohort in Atrial fibrillation and mechanical aortic valve replacement (n=1,086). Lower mean Time in Therapeutic Range (TTR) vs. Higher mean TTR was evaluated on First-ever ischemic stroke (HR 1.23, 95% CI 1.03-1.49, p=0.030). Lower mean Time in Therapeutic Range was associated with a higher risk of ischemic stroke (HR 1.23; 95% CI 1.03-1.49; p=0.030) in patients with atrial fibrillation and mechanical AVR.

synapsesocial.com/papers/6a6230f085eb9dd1581e178d https://doi.org/10.1093/eurheartj/ehad655.1640

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July 23, 2026European Heart JournalOpen Access

Lower TTR linked to ~23% higher ischemic stroke risk in AF and mechanical AVR.

View Full Paper

Ask AI

Bookmark

Why the study?

Population

1,086 patients with atrial fibrillation and mechanical aortic valve replacement, median age 62.8, 27.1%…

Comparison

Vitamin K Antagonist treatment with lower Time… vs Higher Time in Therapeutic Range (TTR)

Design

Cohort

Follow-up

10 years

Key result

Lower mean Time in Therapeutic Range was associated with a higher risk of ischemic stroke (HR 1.23; 95% CI 1.03-1.49; p=0.030) in patients with atrial fibrillation and mechanical AVR.

Authors

JLJoonas Lehto RBRikhard Björn OHOlli Halminen

Discussion

Member takes

Overview

Suboptimal TTR identifies high-risk patients for bleeding, stroke, and death after mechanical AVR with AF; leaves open whether TTR optimization reduces events.

Key Points

This study aims to evaluate the quality of vitamin K antagonist treatment and its relationship to adverse events post mechanical aortic valve replacement in atrial fibrillation patients.
Registry-based analysis from the FinACAF study covering AF patients diagnosed between 2007-2018 in Finland.
Included patients underwent mechanical aortic valve replacement before or after AF diagnosis with a focus on ischemic events and bleeding episodes.
Hazard ratios of complications post-AVR were estimated using the Fine-Gray model adjusted for bleeding and stroke risk factors.
Cumulative incidence estimates showed 12.8% for ischemic stroke and 27.9% for significant bleeding over 10 years post-AVR.
Lower mean Time in Therapeutic Range (TTR) was associated with a higher occurrence of stroke (adjusted HR 1.23, p=0.030).
Higher mortality (71.1% survival at 10 years) linked to lower TTR (adjusted HR 1.56, p<0.001).

Study Design

Type

Cohort (n=1,086)

Multicenter

Yes

Structured PICO

Population

1,086 patients with atrial fibrillation and mechanical aortic valve replacement, without prior bleeding, stroke, or MI, followed for up to 10 years.

Exposure

Vitamin K Antagonist (VKA) treatment with lower Time in Therapeutic Range (TTR)

Comparator

Higher Time in Therapeutic Range (TTR)

Outcome

First-ever ischemic stroke, any bleeding, intracranial bleeding, and myocardial infarction (MI) after AVRhard clinical

Main Result

Hazard Ratio: 1.23 (95% CI 1.03–1.49)

p-value: p=0.030

Cite This Study

synapsesocial.com/papers/6a6230f085eb9dd1581e178d https://doi.org/10.1093/eurheartj/ehad655.1640

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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