Clinical Analysis Of Low Intensity Anticoagulant Therapy After Mechanical Heart Valve Replacement In Inner Mongolia Area

Objective To explore the rational application of low intensity anticoagulant therapy after mechanical heart valve replacement in Inner Mongolia area.Methods We conducted a trail involving 301 patients who received the warfarin anticoagulant therapy after mechanical heart valve prostheses from January 2012 to December 2016 and collected their clinical data.According to the patient’s INR(International Normalized Ratio)value,the dosage of oral warfarin was reached to INR target value 1.8-2.5(AVR:1.8-2.2,MVR,DVR:1.8-2.5),by outpatient review or telephone follow-up.To establish the anticoagulant INR database of patients after cardiac valve replacement surgery,and to record the anticoagulant related complications(bleeding,thrombosis,etc.).These patients were divided into 3 groups(AVR,MVR,DVR)in terms of the different valve prostheses,and then each group was assigned to 3 subgroups according to their INR level: subgroup A: lower than the anticoagulant therapy standard subgroup(INR<1.8),subgroup B: reach the anticoagulant therapy standard subgroup(INR:1.8-2.5,including AVR:1.8-2.2,MVR,DVR:1.8-2.5)and subgroup C: over the anticoagulant therapy standard subgroup(AVR:INR>2.2,MVR,DVR:INR>2.5).Due to the small number of cases in subgroup C,Group C was not compared.We compared the occurrence of the bleeding and thrombosis between subgroups A and subgroup B and investigated the level of low intensity anticoagulant therapy after mechanical heart valve replacement in Inner Mongolia area.Results The actual anticoagulant therapy level in our hospital was INR:1.2-2.2 in AVR group;INR:1.4-2.3 in MVR group and INR:1.3-2.2 in DVR group.There were 20 cases of bleeding,the incidence was about 2.81%patient years.there were 14 cases of thrombosis,the incidence was about 1.96% patient years.The total sample’s average INR value was(1.81±0.26).There were 139(47.1%)case in subgroup A,including 6(4.3%)cases of bleeding and 5(3.6%)cases of thrombosis.There were 156(52.9%)case in subgroup B,including 14(9.0%)cases of bleeding and 9(5.8%)cases of thrombosis..There was no significant difference between the subgroup A and the subgroup B of the total sample in the incidence of bleeding and thrombosis(P>0.05).In AVR group the average INR value was(1.69±0.27).There were 54(68.4%)case in subgroup A,including1(1.9%)cases of bleeding and 3(5.6%)cases of thrombosis.There were 25(31.6%)case in subgroup B,including 3(12.0%)cases of bleeding and 1(4.0%)cases of thrombosis..Therewas no significant difference between the subgroup A and the subgroup B of AVR in the incidence of bleeding and thrombosis(P>0.05).In MVR group the average INR value was(1.88±0.24).There were 45(34.1%)case in subgroup A,including 4(8.9%)cases of bleeding and 1(2.2%)cases of thrombosis.There were 87(65.9%)case in subgroup B,including9(10.3%)cases of bleeding and 6(6.9%)cases of thrombosis.There was no significant difference between the subgroup A and the subgroup B of MVR in the incidence of bleeding and thrombosis(P>0.05).In DVR group the average INR value was(1.88±0.24).There were40(47.6%)case in subgroup A,including 1(2.5%)cases of bleeding and 1(2.5%)cases of thrombosis.There were 44(52.4%)case in subgroup B,including 2(4.5%)cases of bleeding and 2(4.5%)cases of thrombosis.There was no significant difference between the subgroup A and the subgroup B of DVR in the incidence of bleeding and thrombosis(P>0.05).Conclusion There is no difference in anticoagulant efficacy between the low intensity anticoagulant therapy and INR:1.8-2.5(AVR:1.8-2.2,MVR,DVR:1.8-2.5)in our hospital,The low intensity anticoagulant therapy level in our hospital was INR:1.2-1.8 in AVR group;INR:1.4-1.8 in MVR group and INR:1.3-1.8 in DVR group,which is suitable for the patients after mechanical heart valve replacement in Inner Mongolia area.