Clinical Asscessment Of Anticoagulation Therapy Using Warfarin In Cardiac Patients With Mechanical Valve Protheses

Objective:Incorrect anticoagulant therapy is the key risk factor for thromboembolism or hemorrhage complications in patients with mechanical heart valve prostheses.More data should be collected to define the optimal strategy for anticoagulant therapy.In this study,the correlation between international normalized ratio and anticoagulant related complications measured by observing the mitral valve replacement patients after Hua Falin stabilizer in Jining area,to investigate whether INR(international normalized ratio)1.6-2.2 anticoagulation intensity region for anticoagulation,anticoagulation warfarin to guide individualized treatment.Methods:During the first people's Hospital of Jinxiang County People's Hospital of Jining city from January 2009 to February 2015 underwent mitral valve replacement were retrospectively analyzed,and mechanical mitral valve replacement: a report of 318 cases,including 144 cases of male,female 174 cases,age(47.3 ±13.8Y),weight(56.8 ±15.1kg),surface area(1.6 ±0.3m2).6 hours after extubation after oral anticoagulation with warfarin,the initial dose of 2.5-5mg,every day or every other day to detect INR stability after discharge.By telephone follow-up and outpatient review,followed up over 3 months to record the oral dose of warfarin,the incidence of INR and related complications.Statistical analysis was performed.Results:A total of 296 patients were followed up with a follow-up rate of 93.1 %(296 / 318)and a total follow-up of 2664 per patient-year.there were 33 patients with hemorrhage,The total bleeding ratio was 11.1%(7.2% per patient-year)and INR was 1.6-2.2,The bleeding ratio was 2.5%(3.5% per patient-year).The overall embolic ratio was 1.4 %(0.4% per patient-year),INR 1.6-2.2,and the embolization ratio was 1.0 %(0.3% per patient-year).Of 296 patients,92(31.1%)were atrial fibrillation and 204(68.9%)were non-atrial fibrillation.The rate of hemorrhage in the atrial fibrillation group was 10.9%(7.2% per patient-year),and the ratio of non atrial fibrillation group was 11.3%(7.2% per patient-year),4patients with embolism,The embolization ratio was 3.3(0.7% per patient-year)in AF group and 0.5(0.2% per patient-year)in non-AF group.The incidence of anticoagulation-related complications was as follows: there were 33 patients with hemorrhage,including 28 patients with INR > 2.2n = 1.6-2.2n = 1.6-2.2n = 5,with no bleeding,and 4patients with embolism.The value of INR was greater than 2.2,and that of 2 patients without embolization was 1.6-2.2.2 cases of embolization were less than 1.6 or 2 cases.The average oral warfarin dose was(2.69 ±1.02)mg/d,The average INR value of the whole group was 2.12 ±0.47.Conclusion:The main complications of anticoagulant therapy after mitral valve replacement were hemorrhage and thromboembolism.The rate of bleeding was significantly lower than that of embolization(1.6-2.2),but the rate of embolism had no obvious change.Therefore,the INR value of 1.6-2.2 is safe and effective for local patients.Low intensity anticoagulation can reduce bleeding complications without increasing thromboembolic events,but the need for appropriate strengthening of anticoagulant intensity in patients with atrial fibrillation remains to be further demonstrated.