A Clinical Study On Low-intensity Anticoagulation Of Heart Valve Replacement Patients In The South Jiangxi Region

Objective: To explore the efficacy 、 feasibility and safety of low-intensity anticoagulation therapy in the south Jiangxi region after prosthetic heart valve replacement.Methods:116 patients who were enrolled in this study received low-intensity anticoagulation therapy after prosthetic heart valve replacement in The First Affiliated Hospital of Gan Nan Medical University from January 1, 2014 to January 1, 2016. And all patients were followed-up to February 28, 2016. The low-intensity anticoagulation therapy was administered 48-72 hours after operation when the pericardial and mediastinal drainage tubes pulled out. At the first time warfarin doses was2.5mg/d.During hospitalization, the prothrombin time(PT)and international standard ratio(INR) were measured daily or every other day.Warfarin was administered to maintain PT-INR within the assigned range(PT-INR, 1.5-2.2; AVR 1.5-1.8, MVR、TVR、DVR 1.8-2.2).During this period,the oral warfarin dosage, clinical complications, and plasma concentrations of prothrombin, warfarin plasma concentration and PT-INR value were recorded. The patients were followed up by special clinic reexamination, letters,phone calls and so on.The oral warfarin dosage, clinical complications and PT-INR value were also recorded.Statistical analysis was performed with SPSS 18.0 statistics software and measurement data was expressed as means ±SE unless otherwise stated.The differences between groups and among groups were examined by t-test and one way analysis of variance(ANOVA), respectively. count data was analyzed by chi-square.A p value of less than 0.05 was considered statistically significant.Results: In the period of this research, we collected 649 person-times PT-INR,and there were 503 cases( 77.50%) within the target PT-INR 1.5-2.2, 53 cases(8.17%)PT-INR<1.5, 93 cases(14.33%)>2.2.During hospitalization, there were2 cases suffering thromboembolism, the rate of thromboembolism was 1.3%patient-years(Pty), there were 6 cases suffering bleeding, the rate of thromboembolism was 3.89% Pty.The mean maintaining oral warfarin dosage was2.45±0.98 mg.PT-INR value was fluctuated between 1.5-1.9, and the average PT-INR was 1.83±0.42.After discharge,116 patients were followed up(47 males and 69females),3 cases lost follow-up.And 113 cases were actual follow-up.The follow-up rate was 97.4%, and the average follow-up were 1.33 years(range 0.25-2.33years),and the total number was 154.28 Pty.During follow-up,there were no death and severe bleeding cases, 2 thromboembolic events(1.30% Pty) and 2 bleeding events(1.30% Pty) complication occurred. The mean maintaining oral warfarin dosage was2.40±0.86 mg.PT-INR value was fluctuated between 1.5-1.9, The average PT-INR was 1.78±0.42.In this group,there were 8 bleeding events(total hemorrhage rate 5.19 %Pty) and4 thromboembolic events(total thromboembolic rate 2.59 %Pty) occurred.Within the target PT-INR 1.5-2.2,there were 2 patients(2.59 %Pty) hemorrhage occurred,and above the target PT-INR 1.5-2.2, there were 6 patients(3.89 %Pty) hemorrhage occurred.Within the target PT-INR 1.5-2.2,there were 1 patient(0.65% Pty)thromboembolic events occurred,and above the target PT-INR 1.5-2.2, there were 3patients(1.94% Pty) thromboembolic events occurred.The early complications(<3months) included 6 hemorrhage(3.89%Pty) and 2 thromboembolism(1.30%Pty). However, during late follow-up,there were 2 patients(1.30%Pty)hemorrhage and 2 thromboembolism(1.30%Pty) occurred. So the early anticoagulation complications(<3months) event rate was significantly higher than late,and the difference was statistically significant(P<0.05)。Conclusions:1.After heart valve replacement,bleeding is the most important complication of low-intensity anticoagulation in the south Jiangxi region, the early anticoagulation complications event rate was significantly higher than late.2.PT-INR is one of important sensitive indexes in monitoring anticoagulation after heart valve replacement, and has a very important significance for guiding clinicians to safely and effectively adjust the warfarin dose.3. It is acceptable and safe to practice low-intensity anticoagulation therapy afterheart valve replacement in the south Jiangxi region, which can reduce the incidence of thromboembolism and bleeding events.