The recent study by Torn et al1 provides an interesting and insightful prospective analysis of the optimal anticoagulant strategy using vitamin K antagonists. The incidence of major thromboembolic events in 3 patient groups (mechanical heart valves, AF, and myocardial infarction) was analyzed and compared with the incidence of major hemorrhage. As a result of this study, the authors suggest that perhaps a target INR of 3.0 should be used for AF and mechanical heart valves, while an INR of 3.5 should be achieved in those patients who have sustained a myocardial infarction. The nature of the outcome events, however, may be important in modifying these conclusions.
Christopher J. McLeod, Bernard J. Gersh. Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation. Arch Intern Med. 2009;169(21):2032–2033. doi:10.1001/archinternmed.2009.420