Analysis Of The Influencing Factors Of Warfarin Anticoagulation Therapy In Patients Undergoing Heart Valve Replacement Surgery

OBJECTIVE:To investigate the influencing factors of warfarin anticoagulant therapy after heart valve replacement.Methods:Data were collected from patients who received warfarin after second heart valve replacement in the Department of Cardiac Surgery,the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020.Aortic valve replacement(AVR)for sinus rhythm has an INR range of 2.0-3.0,and mitral valve replacement(MVR)and all HVR patients with atrial fibrillation have an INR range of 2.0-3.0.The patient’s age,gender,height,weight,duration of operation and operation method were recorded.Laboratory results were collected on the first postoperative day,including white blood cell count,hemoglobin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),plasma albumin,and serum creatinine;Postoperative use of other drugs,such as cefotiam,cefoperazone and sulbactam,vancomycin,amiodarone,etc.,bleeding and thrombosis events were recorded,and INR values at discharge were recorded.The target range of INR value was 2.0-3.0.According to the INR value reaching the target when patients were discharged,the INR value within the target range was considered as the target group,and the INR value outside the target range was considered as the non-target group.Univariate analysis was carried out for all available clinical factors,and multivariate analysis was carried out for factors with univariate analysis P<0.05,and a P<0.05 model algorithm was obtained.Warfarin knowledge education was conducted for the patients who planned to undergo heart valve replacement,and the patients were instructed to complete the Warfarin Anticoagulant Knowledge Assessment(AKA)questionnaire before discharge,and the results of the questionnaire were recorded and analyzed.Result:1 General clinical characteristics of patientsOf the 301 patients who met the inclusion criteria,8 were excluded due to the following reasons:5 patients started using warfarin on the second day after surgery,and 3 patients lost follow-up before reaching the INR(Tongshun).Goal Range:The average measured value of INR in the previous 30 days was 7.29±2.3.2 Univariate analysis of INR valueUnivariate analysis for,reaching INR value:Univariate analysis showed that length of hospital stay,BMI,postoperative use of cefotiam,postoperative use of cefoperazone and sulbactam,and the number of times of INR monitoring were the influencing factors for reaching INR value(P<0.05).There was no statistical significance in age,sex,postoperative white blood cell count,hemoglobin,ALT,AST,albumin,serum creatinine,postoperative use of vancomycin,amioodarone,valve position,operation time and other factors.3 Multivariate analysis for reaching INR valueAfter univariate analysis,factors with P<0.05,namely postoperative use of cefotiam,postoperative use of cefoperazone and sulbactam,BMI,postoperative hospital stay,and monitoring INR value times(>10)were included in the Logistic regression model.Failure to reach the INR value is marked as 0,and failure to reach the INR is marked as 1.The final results showed that the probability of reaching the target was lower in patients receiving eefotiam than in patients not receiving cefotiam[OR=0.320,95%CI(0.043,0.672)],The INR value of postoperative cefoperazone and sulbactam patients was more likely to reach the target than that of non-cefoperazone and sulbactam patients[OR=2.452,95%CI(1.032,6.333)].Patients whose INR was monitored for>10 times were more likely to reach the target than these whose INR was monitored for ≤10 times[OR=6.801,95%CI(2.048,21.112)].4 AKA questionnaire survey resultsAKA Questionnaire Results:The average score of the AKA Questionnaire was 64.3±5.8 points.None of the patients who participated in the questionnaire scored full.Sixty-eight percent of patients answered all 12 questions correctly.The question with the highest rate of inaccuracy involved the interaction between the drug and warfarin,with 58 people choosing the wrong answer(19.2 percent)and 183 people choosing the wrong answer(60.7 percent).When asked about the duration of warfarin treatment,233 patients(77.4%)did not indicate that warfarin treatment was lifelong,while 5 patients(2.6%%)did not select an answer.Conclusion:The frequency of INR monitoring(>10),postoperative use of cefotiam,and use of cefoperazone and sulbactam were the main factors for achieving INR of warfarin anticoagulation after heart valve replacement.Patients with higher warfarin knowledge can improve compliance and thus the anticoagulant efficacy of warfarin.Warfarin education for patients should focus on the interaction of warfarin with drugs,diet and traditional Chinese medicine.These findings may provide the basis for individualized treatment of anticoagulation use in warfarin patients.