Warfarin Adjustment And Quality Of Life In MHV Patients Undergoing Non-cardiac Surgery

Research background and purposeMechanical heart valve(MHV)patients undergoing non-cardiac surgery refer to patients undergoing re-operation due to non-cardiac diseases after mechanical heart valve replacement.Because mechanical heart valves readily activate clotting factors in the blood to form thrombus,these patients require lifelong oral warfarin anticoagulation.It has been found that adjusting the international normalized ratio(INR)for patients undergoing non-cardiac surgery for MHV before non-cardiac surgery can prevent valve thrombosis while reducing the risk of bleeding,and is beneficial to improve the quality of life of patients.However,the INR require blood testing in the hospital and a long wait time for results.If the target management of INR value can be achieved by adjusting the preoperative discontinued of warfarin,the self-management of preoperative anticoagulation in patients with MHV non-cardiac surgery can be improved and the blind discontinued of warfarin before operation can be avoided.But current research guidelines do not provide guidance on the timing of preoperative warfarin discontinuation in MHV patients undergoing non-cardiac surgery.Quality of life is used as a criterion to evaluate the physiological and psychological effects of disease treatment on patients,which is helpful to evaluate the treatment effect of noncardiac surgery and the survival status of MHV patients with non-cardiac surgery.The purpose of this study is to investigate the preoperative warfarin adjustment time and quality of life in MHV patients undergoing non-cardiac surgery,and to analyze the related influencing factors.Materials and MethodsThe subjects of this study were MHV patients with non-cardiac surgery,and the data of the study subjects were collected through the hospital information system of a tertiary hospital in Chongqing.The study subjects were followed up with questionnaires before and after non-cardiac surgery.This study analyzed the preoperative anticoagulation adjustment and postoperative quality of life in MHV patients undergoing non-cardiac surgery.The first,reviewed the case data of 121 patients with MHV non-cardiac surgery in a tertiary hospital in Chongqing.t-test,multivariate regression and other methods were used to explore the changes of different warfarin withdrawal times corresponding to International normalized ratio INR and compared the effects of different INR ranges on surgical bleeding after interruption of anticoagulation.The second,investigated and followed up 116 MHV patients with noncardiac surgery.Data on MHV patients with undergoing noncardiac surgery were collected using questionnaires and SF-12 quality of life scale,including the basic information of the participants age,sex,occupation,education level,history of chronic diseases,type and time of mechanical valve replacement,type of non-cardiac surgery,time of preoperative interruption of anticoagulation,and quality of life scale SF-12.The Epidata 3.1 was used to establish a database and data entry,and SPSS 26 statistical software was used for data processing and analysis.The statistical analysis of data was carried out by t-test,analysis of variance and multivariate regression.ResultsIn retrospectively,84.7% of the 121 MHV patients with noncardiac surgery were young and 79.3% were female.Atrial fibrillation accounted for 30% of patients with chronic diseases,with bleeding rate of 1.7% and thrombosis rate of 0.8%.The surgical types mainly included laparoscopic total hysterectomy and double adnexectomy in 46 cases,accounting for 38.0%,laparoscopic cholecystectomy in 38 cases,accounting for31.4%,and other operations in 30.6%.Statistical analysis showed that the mean INR was 1.33±0.351 for warfarin withdrawal 3 days,1.15±0.158 for warfarin withdrawal3-7 days,and 1.02±0.09 for warfarin withdrawal >7 days.By comparison,there was no significant difference in intraoperative blood loss between the patients with different discontinued of warfarin.A total of 133 MHV patients with non-cardiac surgery were investigated for quality of life,and 9 cases of lost follow-up and 8 cases of missing data were excluded.Finally,116 patients were effectively followed up,and the effective recovery rate of questionnaire was 93.5%.There were 85 female patients,accounting for 73.3%.The surgical types of MHV patients with non-cardiac surgery mainly included obstetric and gynecologic surgery in 46 cases,accounting for 39.6%.Laparoscopic cholecystectomy was performed in 29 cases,accounting for 25%.The remaining operations accounted for about 33.4%.The Cronbach ’ α coefficient of SF-12 was 0.952.The internal consistency of SF-12 was greater than 0.9.The half-and-half reliability of the whole scale was 0.947.Validity was analyzed by AMOIS confirmatory factor analysis,the good-fit-index GFI of the scale is greater than 0.9,and the root mean square error of approximation RMSEA is less than 0.05.SF-12 quality of life survey showed that the total score of quality of life of MHV patients with non-cardiac surgery at 6months after operation was higher than that before operation.Six months after surgery,the patient’s mental health improved compared with the preoperative period.The physical health score was higher than before,but there was no statistically significant difference.Anticoagulation-related complications occurred in 1.7% of MHV patients with non-cardiac surgery.Changes in quality of life in patients 6 months after noncardiac surgery were associated with complications of non-cardiac surgery type and complication of non-cardiac disease treatment.Conclusions1.In MHV patients with non-cardiac surgery,warfarin should be discontinued with low molecular weight heparin bridging before non-cardiac surgery.If the INR is normalized(≤1.2),it is recommended to stop warfarin for 3-7 days before surgery;if INR ≤1.5,it is recommended to stop warfarin for ≤ 3 days.It is helpful for MHV patients with non-cardiac surgery who to self-manage anticoagulation before surgery or invasive procedures and avoid blind discontinuation of warfarin.2.The result show that there was no significant increase in anticoagulation-related complications after noncardiac surgery in MHV patients with non-cardiac surgery who discontinued warfarin.Therefore,when MHV patients with non-cardiac diseases require surgical treatment,non-cardiac surgery will not significantly increase the risk of anticoagulation-related complications under standardized anticoagulation therapy.3.The quality of life of MHV patients with non-cardiac disease can bone improved to some extent by necessary surgical treatment.The quality of life of MHV patients with non-cardiac surgery at 6 months after surgery was affected by the type of non-cardiac surgery and postoperative complications,while intracranial,thoracic and abdominal surgery had a greater impact on the quality of life of patients due to postoperative complications,and the quality of life of patients after limb and superficial surgery was significantly improved.4.In order to improve the quality of life of MHV patients with non-cardiac surgery,it is still necessary to prevent and provide health guidance for the complications of noncardiac disease treatment in the patients,which can help the patients recover long-term physical functions,thereby improving the quality of life of the patients.