Clinical Observation Of Warfarin Initial Anticoagulant After Cardiac Valve Replacement

Objective:Retrospective analysis of warfarin anticoagulant treatment in patients undergoing heart valve replacement in our hospital,we explored the factors influencing the first standard time of the international standardized ratio of prothrombin time(INR)after postoperative.Methods:According to the strict inclusion and exclusion criteria,we selected 138 patients received warfarin anticoagulant therapy after cardiac valve replacement from January2014 to April 2017 in our hospital.We We gathered their clinical data,consisted of The general index(gender,age,height and weight),preoperative indexes(heart function,atrial fibrillation,thrombus),preoperative index(left atrial and left ventricular ejection fraction),operation index(operation method,cardiopulmonary bypass time and cross-clamping time),Postoperative index(postoperative INR monitoring value,postoperative complications)and so on.According to the first arrival of INR after operation,the patients were divided into 4 groups: group I: 3-4 days to reach the standard;group II : 5-6 days to reach the standard;group III: 7-8 days to reach the standard;group IV: greater than or equal to 9 days to meet the standard.Analyzing the correlation of various factors for the first standard time by statistic method.Results:No death occurred in all patients during hospitalization.Postoperative anticoagulation related complications occurred in 9 cases(6.52%),including bleeding in7 cases(5.07%)and thromboembolism in 2 cases(1.44%).INR value monitoring: 6cases were exceeding the standard after operation,22 cases were not qualified,110 cases were qualified.The INR value was stable in 19 cases,17 cases of INR > 3,and 2 cases of INR > 4.The single factor statistical analysis: 1.age and gender: the average age of four standard time respectively: 47.61 + 12.372,53.24 + 12.269,54 + 8.815,56.88 + 9.107,the four groups was statistically significant difference in age(P < 0.05);the four groups of gender is not statistically significant(P > 0.05).2.body surface area and body mass index: the body surface area of four standard time periods is 0.54 + 0.084,0.64 + 0.119,0.60 + 0.121,0.60 + 0.109,the difference is statistically significant(P < 0.05);the body mass index of the 0.05 group has no significant difference(P > 0.05).3.cardiac function,left atrial artery and ejection fraction: there was no significant difference in cardiac function,left atrial ejection fraction and left ventricular ejection fraction between the four groups(P > 0.05).4.atrial fibrillation and thrombus: there was no significant difference between four groups of atrial fibrillation and thrombus(P > 0.05).5.tricuspid valvuloplasty and operation methods: four groups with tricuspid valvuloplasty,the difference was statistically significant(P < 0.05),and compared between the four groups,there was no statistically significant difference(P > 0.05).6.cardiopulmonary bypass time and auxiliary time: there was no statistically significant difference between the four groups in terms of cardiopulmonary bypass time and aorta interruption time(P > 0.05).Multivariate statistical analysis showed that age and tricuspid valvuloplasty had an impact on the first standard time(P < 0.05).Conclusion:Age and Pulmonary hypertension are the influence factors of the first standard time for INR after cardiac valve replacement.Gender,body mass index,body surface area,cardiac function,atrial fibrillation,thrombus,left atrium,ejection fraction,operation mode and cardiopulmonary bypass time had no significant effect on the first standard time of INR.