The Compliance Of Early Anticoagulant Therapy And Its Influencing Factors In Patients Undergoing Mechanical Heart Valve Replacement

Objective1To discuss the early adherence of warfarin anticoagulant treatment;2To explore the influence factors of the adherence of anticoagulant therapy in patients undergoing mechanical heart valve replacement.Methods1To design anticoagulant warfarin treatment compliance questionnaire and warfarin anticoagulation cognitive questionnaire about the patients after mechanical heart valve replacement and examine the questionnaire’s reliability and validity.2To discuss the early warfarin therapy in patients with warfarin treatment compliance questionnaire, warfarin cognitive questionnaire,SAS, sSDS and SSRS.3The patients receiving mechanical heart valve replacement in the first affiliated hospital of Zhengzhou University for1～12,2011. In the process of questionnaire entries screening,200nurses were selected. The investigated method was to fill in questionnaires face to face or telephone follow-up, the time of the investigation of each patient was6months after hospital discharge, and the termination time was June31,2012.4SPSS17.0statistical software was used to analyze the data, and statistical analysis included descriptive statistics, Pearson correlation analysis, t-test, and multiple linear regression.Results1The CVI,Cornbach ’s α value and the secondary reliability of the anticoagulant treatment compliance questionnaire and the anticoagulant cognitive questionnaire were respectively0.80and0.85,0.78and0.82,0.88and0.86.27patients was missed because cases of the change of telephone number and could not come to outpatient, the rate of lost to follow-up was3.9%. A total of193questionnaires,187questionnaires were recovered, the rate was96.9%, and the number of effective questionnaires were180, the effective rate was96.3%.3The score of the anticoagulant cognitive questionnaire of warfarin were4-15(9.36±2.98), the percentage of poor cognitive degree, general cognitive degree and good cognitive degree was respectively40.6%,35.7%and23.7%; Regression analysis results showed that patients with whether to accept warfarin anticoagulation guidance, social support, and depression in patients with degree and reside a dwelling place were the significantly associated with the score of warfarin anticoagulation cognitive.4The score of SAS and SDS was41.43±8.06and43.27±10.37, were higher than those of the domestic norm standard score, the difference was statistically significant (P<0.01).The social support score was43.29±8.68, including subjective support score for27.57±13.25, objective support score for9.79±3.36, the use to support degree score for7.78±2.56.5The score of the adherence of early warfarin anticoagulant therapy in patients was19～32(27.25±3.02). Regression analysis showed that, anticoagulant related complications, warfarin anticoagulation cognitive score, employment status and cultural level were the significant effects of the adherence of early warfarin anticoagulant therapy.Conclusions1The level of the anticoagulant cognitive of warfarin is urgently to improve. The level of warfarin knowledge,self-efficacy and SDS scores are significant predictors of warfarin compliance. The medical staff could improve patients’ warfarin knowledge by enhancing patient’s oral anticoagulant therapy health education, improving patients’ social support, alleviating patients’depression and and nursing intervention, especially for the rural patients.2The level of adherence of early warfarin anticoagulant therapy in patients is urgently to be improved, especially anticoagulation monitoring compliance and lifestyle compliance. It means that medical personnel should strengthen the health education knowledge in clinical medical nursing practice.3The anticoagulation cognitive score, anticoagulant related complications, employment status and cultural level are significant predictors of compliance of anticoagulant therapy, indicating that the medical staff should strengthen the patients of anticoagulant warfarin knowledge propaganda and education, especially for lower cultural level, not happened or not found anticoagulation related complications in patients with on-the-job work, setting individualized nursing intervention measures to improve the patients’ adherence of anticoagulant therapy.