Study On Anticoagulant Management Of Patients After Cardiac Valve Replacement-Single Center Sampling

Objective: To investigate the status of anticoagulation in patients after cardiac valve replacement and to evaluate the quality of anticoagulation therapy.Methods:140 patients who need the use of warfarin anticoagulation with mechanical heart valve replacement for half a year,during the time from January 2013 to December 2014 in People's Hospital of Guizhou Provience was been randomly selected.their clinical data were analyzed retrospectively by analyzing the incidence of thromboembolism and bleeding events associated with anticoagulation therapy.the anticoagulation quality was evaluated by calculating the patient's TTR.the patients using traditional anticoagulant management model and insisting follow-up in our hospital and whose follow-up time interval for the two review was less than 90 days,whose total number of times of review was more than 3 times during the follow-up period were divided into group A,The patients using traditional anticoagulant management model and insisting follow-up in our hospital and whose follow-up time interval for the two review was beyond 90 days and whose number of times of review was less than 3 times during the follow-up period were divided into group B,compared the two groups in age,gender,the time spent on each review and economic costs in each follow-up,companion needed or not for each review by statistical analysis to find the factors related to follow-up compliance of patients with anticoagulation.Results:Among 140 patients selected,21 patients were lost to follow-up,119 patients were followed up,there were 3 death in all follow-up patients(2.52%).7 were in self-managed model,others were in the traditional anticoagulant management model,no other model was found,60 patients in group A with INR detection value of a total of 692 times,of which the lowest INR value of 0.84,the highest value of 6.75,the patient's INR value in the extreme low anticoagulant level accounted for 26.16%,the relative safety of the area accounted for 70.63%,extreme high anticoagulant level accounted for 6.62%,the TTR of patients in group A was calculated by linear interpolation method,it was ranged from 0 to 78.8%,the average TTR was(26.0±19.1)%.two groups of patients with gender,age and the time required for each review had no statistical significance(P >0.05),the difference between the two groups whether need friends and relatives to accompany or not and the cost on each review existed significant differences(P <0.05).Conclusion: The anticoagulant quality of patients is not ideal under traditional anticoagulation model,strengthening follow-up is an effective way to improve the safety of anticoagulation,it is necessary to explore a better time-economic management model for patients to provide more convenience.there are spontaneous users of self-management model,which need further research to prove its safety.patients who require to be accompanied by others for each review or who spend relatively large financial resources for a single review have relatively poor compliance,anticoagulant managers should strengthen the follow-up on them.