The Correlation Between The Intensity Of Anticoagulant Therapy And Incidence Of Complication In Patients After Mechanical Heart Valve Replacement

AIM：To study the optimal international normalized ratio (INR) of the warfarinanticoagulant therapy after mechanical heart valve replacement and to explore itsrelationship with the adverse-events in China. METHODS：we conducted a trail involving1984patients received the warfarin anticoagulant therapy after mechanical heart valveprostheses from December2007to September2012and had long-term follow-up ofcompliance. These patients were divided into3groups (AVR,MVR,DVR) in terms of thedifferent valve prostheses, and then each group was assigned to four subgroups accordingto their INR level (1.4-1.7,1.7-2.0,2.0-2.3and2.3-2.6)，to compare the occurrence of thebleeding and thrombosis among these subgroups.935male and1049female, aged from 16to75years old. The cases with the atrial fibrillation or left atrial thrombus respectivelywere826and331before the surgery.[hypertension457, diabetes mellitus86, receivingprior heart surgery32, NYHA classification(Ⅰ94,Ⅱ680,Ⅲ1072, IV138)]. There are702in the AVR group,795in the MVR group,487in DVR group. RESULTS: In AVR group,the incidences of bleeding in the subgroups with the INR level at1.4-1.7and1.7-2.0havedecreased significantly compared with the level at2.0-2.3and2.3-2.6. In the groups ofMVR and DVR, the incidences of bleeding in the level of INR1.4-1.7,1.7-2.0and2.0-2.3was lower than the2.3-2.6subgroup. However, the incidence of thrombosis in all INRlevels has no significant statistic differences. CONCLUSION: The present studysuggested that the level of INR at1.4-2.3are appropriate after the anticoagulation therapyin the MVR and DVR patient. The safe range of taking warfarin for AVR patient is INR1.4-2.0.