| Objective:We conducted a follow-up investigation into anticoagulation-related complications of warfarin use after heart valve replacement in Qingdao area in the hope that it could be used to improve quality of life in patients with anticoagulation complcations after heart valve replacement,the anticoagulation complcations of patients after heart valve replacement with bioprosthesis and mechanical valve were compared and analyzed,and to provide some theoretical basis for choices of heart valve prosthesis types.Methods:Eight hundred eighty-eight patients undergoing heart valve replacement from 1January 2012 to 31 December 2014 in the Department of Cardiovascular Surgery of Qingdao University Hospital were enrolled and followed.Anticoagulant drug use,complications,and deaths from anticoagulation were recorded.For statistical analyses,patients were grouped according to the types of heart valves.Group Ⅰ: Mechanical prosthesis vs Bioprosthesis;Group Ⅱ: With atrial fibrillation vs Without atrial fibrillation;Group Ⅲ: Mechanical prosthesis with atrial fibrillation,Mechanical prosthesis without atrial fibrillation,Bioprosthesis with atrial fibrillation,Bioprosthesis without atrial fibrillation.Statistical analyses were conducted for comparative results of anticoagulation complications between different types of valve prostheses and whether or not there was atrial fibrillation.Results:Follow-up was completed in 803 cases,with a follow-up rate 90.43%.Thirty-one patients who died during post-operative hospitalization were excluded and the remaining772 patients were included.There was a total of 2590.59 person-years of follow-up.Thenumber of anticoagulation complications was statistically analyzed using person-times.In the mechanical valve group,there were 142 person-times of anticoagulation-related hemorrhage(11.81%/year)and 13 person-times(1.08%/year)of embolization.There were 155 person-times of total events.In the bioprosthesis group,there were 48person-times of anticoagulation-related hemorrhage(3.46%/year)and 13 person-times(0.94%/year)of embolization.Total events occurred 155 person-times.Anticoagulation-related hemorrhage in patients with atrial fibrillation occurred 111person-times(11.31 %/year),embolization occurred 18 person-times(1.83 %/year).Total events were 129 person-times.Anticoagulation-related hemorrhage in patients without atrial fibrillation occurred 79 person-times(4.91 %/year),embolization occurred 8person-times(0.50 %/year),Total events occurred 87 person-times.In the mechanical valve with atrial fibrillation group,there were 72 person-times of anticoagulation-related hemorrhage(14.16%/year)and 8 person-times(1.57%/year)of embolization.Total events occurred 80 person-times(15.73 %/year).In the mechanical valve without atrial fibrillation group,there were 70 person-times of anticoagulation-related hemorrhage(10.09 %/year)and 5 person-times(0.72 %/year)of embolization.Total events occurred 75 person-times(10.81 %/year).In the bioprosthesis with atrial fibrillation group,there were 39 person-times of anticoagulation-related hemorrhage(8.25%/year)and 10 person-times(2.12%/ year)of embolization.Total events occurred49 person-times(10.37 %/year).In the bioprosthesis without atrial fibrillation group,there were 9 person-times of anticoagulation-related hemorrhage(1.31 %/year)and 3person-times(0.33 %/ year)of embolization.Total events occurred 12person-times(10.37 %/year).There was a total of 216 person-times(8.34%/year)for all four groups.Of those,anticoagulation-related hemorrhage occurred 190person-times(7.33 %/year),embolization occurred 26 person-times(1.00 %/year).The incidence of anticoagulation-related bleeding and overall events were higher in the mechanical valve group than the bioprosthesis group(P<0.000 and P<0.000,respectively),and the incidence of embolization was not statistically different(P> 0.5)compared with the bioprosthesis group.The incidence of anticoagulation-related bleeding and overall events were higher in patients with atrial fibrillation than those without atrial fibrillation(P<0.000,P<0.0001 and P<0.000,respectively).The incidence of anticoagulation-related bleeding and overall events were higher in the mechanical valve with atrial fibrillation group than the mechanical valve without atrial fibrillation group(P<0.05 and P<0.025,respectively),and the incidence of embolization was not statistically different(P> 0.1).The incidence of anticoagulation-related bleeding,embolization and overall events were higher in the bioprosthesis with atrial fibrillation group than the bioprosthesis without atrial fibrillation group(P<0.000,P<0.0001 and P<0.000,respectively).The incidence of anticoagulation-related bleeding and overall events were higher in the mechanical valve with atrial fibrillation group than the bioprosthesis with atrial fibrillation group(P<0.01 and P<0.025,respectively),and the incidence of embolization was not statistically different(P> 0.5).The incidence of anticoagulation-related bleeding and overall events were higher in the mechanical valve without atrial fibrillation group than the bioprosthesis without atrial fibrillation group(P<0.000 and P<0.000,respectively),and the incidence of embolization was not statistically different(P> 0.25).Conclusion:Under the current protocol at our institution with respect to duration of anticoagulation and intensity,anticoagulation-related hemorrhage complications in patients with mechanical valve replacement were higher than the bioprosthesis group,under the precondition of the average age of the bioprosthesis group was higher than that of the mechanical valve group,the incidence of embolization related complications in the bioprosthesis group was not higher than that in the mechanical valve group,which reflected a better quality of life in the bioprosthesis group compared with the mechanical valve group. |
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