Anticoagulation early after mechanical valve replacement: improved management with patient self-testing. J Thorac Cardiovasc Surg 2013 Sep;146(3):599-604
Date
08/28/2012Pubmed ID
22921821DOI
10.1016/j.jtcvs.2012.03.088Scopus ID
2-s2.0-84881616330 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
OBJECTIVE: Self-testing to determine the international normalized ratio improves management with warfarin and reduces the risks of adverse events. Self-testing usually begins several weeks after hospital dismissal after valve replacement. We aimed to compare the in-hospital initiation of international normalized ratio self-testing with usual care in mechanical heart valve recipients.
METHODS: A total of 200 adult mechanical heart valve recipients were randomly assigned to in-hospital international normalized ratio self-testing instruction or usual care. Instruction for self-testing patients began on the fourth postoperative day. The patients were followed up for 3 months to compare the number of international normalized ratio tests, percentage of time in the therapeutic range, and adverse events.
RESULTS: The baseline characteristics were similar between the 2 groups. During the first 3 postoperative months, the usual-care group underwent an average of 10 international normalized ratio tests, and the self-testing group completed 14 international normalized ratio tests. The mean ± SD percentage of international normalized ratio tests within the therapeutic range was 45% ± 22% for the usual-care group and 52% ± 22% for the self-testing group (P = .05). Within 90 days after dismissal, transient ischemic attack occurred in 1 patient in the usual-care group and 2 patients in the self-testing group. Bleeding complications occurred in 3 patients in the usual-care group and 5 patients in the self-testing group.
CONCLUSIONS: Management of anticoagulation with warfarin after mechanical valve replacement is improved with self-testing, even during the early postoperative phase when international normalized ratio testing is performed frequently. Although the incidence of adverse events was similar in the 2 groups, better control of the international normalized ratio would be expected to improve outcome in large populations of patients.
Author List
Thompson JL, Burkhart HM, Daly RC, Dearani JA, Joyce LD, Suri RM, Schaff HVMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Anticoagulants
Blood Coagulation
Chi-Square Distribution
Drug Monitoring
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Hemorrhage
Humans
International Normalized Ratio
Male
Middle Aged
Minnesota
Patient Discharge
Predictive Value of Tests
Prosthesis Design
Self Care
Time Factors
Treatment Outcome
Warfarin
Young Adult
