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Objective@#To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery.@*Methods@#Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies.@*Results@#A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events.@*Conclusion@#LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
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Objective: To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery. Methods: Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies. Results: A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events. Conclusion: LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
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Humanos , Anticoagulantes/uso terapêutico , Valvas Cardíacas , Heparina , Heparina de Baixo Peso Molecular , Tromboembolia/tratamento farmacológicoRESUMO
Objective To explore the effect of peer education among discharged patients after mechanical heart valve replacement. Methods A total of 84 patients undergoing mechanical heart valve replacement in hospital from August to December 2016 were enrolled and randomly divided into two groups, 42 cases in each group. All of the patients received routine discharge guidance and outpatient follow-up after discharge from hospital, based on the same medical treatment, the experimental group were given peer education, and the intervention was provided from one month to six month after discharge, afterwards, anticoagulant knowledge, anticoagulant therapy compliance and complication rates were compared between the two groups discharged the same day, 1 months, 3 months, and 6 months after discharge. Results There was no significant difference in each of the evaluation index between the two groups discharged the same day (P>0.05). The anticoagulant knowledge and anticoagulant therapy compliance of the experimental group were higher than those of the control group at 1, 3, 6 months after the intervention (χ2=6.102, 7.378, 12.210, P<0.05 or 0.01), and the incidence of complications was lower than that of the control group at 6 months after the intervention (χ2=3.859, 5.765, 8.278, P<0.05 or 0.01). At 6 months after intervention, the incidence of complications in the experimental group was lower than that in the control group (χ2=5.486, P<0.05). Conclusion Peer education among discharged patients after mechanical heart valve replacement can improve their anticoagulant knowledge and anticoagulant therapy compliance, and reduce the incidence of complications caused by inappropriate anticoagulation.
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Objective To investigate the current status of self-management in patients after mechanical heart valve replacement(MHVR) and the influential factors. Methods The convenience sampling method was used to obtain the sample in Chongqing Province, and 400 participants after MHVR at a month in 3 top three hospitals were recruited (Department of Cardiothoracic Surgery, the First Hospital of Chongqing Medical University. The Second Clinical Medical College of Third Military Medical University. The Third Clinical Medical College of Third Military Medical University). Self-Management Scale for patients after Mechanical Heart Valve Replacement edited by ourselves were used to collect the data. Results The score of patients were 79-119 (96.81 ± 7.86) points. The influential factors were sex, age, education level and the resident manner. Conclusions The self-management level of patients after MHVR is not so bad, the male, advanced age, live with distant relatives or housemaid, low education level's patients' self-management ability are low, the medical workers should strenghen health education in these patients.
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Objective To explore the relationships among social support , belief about medicine and adherence to anticoagulation treatment,and mediating effect of belief about medicine on the relationship between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement. Methods Totally 154 patients were recruited. The social support scale, the modified Chinese Version Morisky Medication Adherence Scale( MMAS-8) and belief about medicine scale were used and the information on patients were collected through clinic and telephone interviews. Results The social support was correlated with belief about medicine (r=0.441, P<0.05). The belief about medicine was correlated with adherence to anticoagulation treatment (r=0.441, P<0.05). The social support was correlated with adherence to anticoagulation treatment (r=0.300, P<0.05) . The mediator effect of the belief about medicine was tested between social support and adherence to anticoagulation treatment. In the result, with the influence of belief about medicine .The social support was not correlated with adherence to anticoagulation treatment ( B=0.020,P>0. 05). Conclusion Belief about medicine plays a completely mediating role in the relation between social support and adherence to anticoagulation treatment.
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@#The patients with mechanical prosthetic valve replacement need anticoagulant therapy for all their life. The incidence of thromboembolism and anticoagulation-related bleeding events still account for major postoperative complications after mechanical heart valve replacement. Most of the complications happen in the first half year after operation. Therefore, early anticoagulation therapy is very important. Of course, so far most guidelines focus stating their opinions on long-term anticoagulant therapy. However, there is no consensus about anticoagulant therapy in the early period of postoperation. In this review, we summarize early anticoagulant therapy of the patients with mechanical heart valve replacement through consulting domestic and abroad relevant research in recent years and give an overview of the present situations of early anticoagulant therapy.
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It is reviewed in this article that the current situation of patients′ adherence to anticoagulation with warfarin after mechanical heart-valve replacement and the measures to improve the situation. Now the adherence situation of the patients is not satisfying to some extent. There are many things we can do to improve the adherence of patients and get a better anticoagulant effect, such as enhancing the health education according to the different background of patients, strengthening the social and psychological support, carrying out effective follow-up and information communication with the patients, the use of the medicine branch box, importing the foreign managing model of self-test and self-manage, expanding the special outpatient service for anticoagulation instruction. We may get a better adherence of anticoagulation with warfarin and improve the prognosis of patients.
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It is reviewed in this article that the current situation of patients′ adherence to anticoagulation with warfarin after mechanical heart-valve replacement and the measures to improve the situation. Now the adherence situation of the patients is not satisfying to some extent. There are many things we can do to improve the adherence of patients and get a better anticoagulant effect, such as enhancing the health education according to the different background of patients, strengthening the social and psychological support, carrying out effective follow-up and information communication with the patients, the use of the medicine branch box, importing the foreign managing model of self-test and self-manage, expanding the special outpatient service for anticoagulation instruction. We may get a better adherence of anticoagulation with warfarin and improve the prognosis of patients.
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Aim To explore the effect of genetic poly-morphisms of POR on the stable warfarin maintenance doses in Han Chinese patients receiving mechanical heart valve replacement. Methods The association between POR gene polymorphisms and warfarin doses of 185 Han Chinese patients were investigated through ANOVA or t test. SNPs of POR and VKORC1 were de-tected by Sequenom? DNA MassArray genotyping method. CYP2C9*3 was genotyped by polymerase chain reaction-restriction fragment length polymorphism method ( PCR-RFLP ) . Patients ’ clinical characteris-tics, INR value and daily dose were obtained from their medical records. Statistical analysis was performed by SPSS 21. 0 software. Results No mutant carriers of POR rs17148944 , POR rs56256515 and rs72553971 were found in this study. The genotype frequencies of other SNPs were in accordance with Hardy-Weinberg e-quilibrium. In the group of patients with CYP2C9*1*1 , the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(3. 50 ± 1. 07) mg·d-1 vs (3. 14 ± 0. 94) mg· d-1,P =0. 03. Also, in the group of patients with CYP2 C9*1*1 and VKORC1 rs9934438 G allele carri-ers, the mutant type carriers ( T carriers ) of POR rs17685 had a significantly higher dose than CC carri-ers(4. 76 ± 0. 90) mg·d-1 vs (4. 08 ± 1. 03) mg· d-1 ,P=0. 04. No significant difference was found in different genotypes of POR rs2868177 . Conclusion These results illustrate that POR rs17685 T carrier is closely associated with a higher warfarin maintenance dose, suggesting that this SNP is useful for clinical guidance of warfarin.
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OBJECTIVE:To reduce the incidence of complications in anticoagulant treatment for patients with mechanical heart valve replacement.METHODS:The factors affecting the anticoagulative efficacy of warfarin were analyzed,and pharmaceutical care was performed for patients to provide them with guidance about the standard use of warfarin in case of the problems likely occurred during the anticoagulant treatment.RESULTS & CONCLUSION:The anticoagulative efficacy of warfarin was influenced by many factors.It is important for pharmacists to carry out active,reasonable and effective pharmaceutical care so as to reduce the incidences of bleeding and thrombus during anticoagulant treatment,avoid drug-induced physical lesions and improve patients' quality of life after surgery.
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OBJECTIVE:To explore the function and approach of clinical pharmacists' participating in the anticoagulation management of patients who had been discharged from hospital after undergoing mechanical heart valve replacement.METHODS:The experiences of clinical pharmacists obtained through first-hand practice in the anticoagulation management and pharmaceutical care of the patients who had been discharged from hospital after undergoing mechanical heart valve replacement were introduced by illustrating examples.RESULTS & CONCLUSION:Clinical pharmacists' participating in the anticoagulation management of patients who had been discharged from hospital after undergoing mechanical heart valve replacement provide physicians and patients with pharmaceutical information and pharmaceutical care and enhance the effectiveness and safety of anticoagulative therapy accordingly.