Clinical Research For Low Intensity Anticoagulation Therapy After Mechanical Heart Valve Replacement In China

Objective To investigate the optimal anticoagulation intensity suit for chinese patients after mechanical heart valve replacement. Methods All cases which must have completed in-and out-patient data were from the Fu Wai Hospital database about chinese anticoagulation therapy after mechanical heart valve replacement. From Feburary2011to December2011, We have collected840cases (395male and445female; the mean of age of50.5±12.1years; mean body height of164.0±8.6cm; mean body weight of63.7±13.0kg; mean body surface area of1.7±0.2m2). The clinical follow-up data from the first day after mechanical heart valve replacement for every case to May2012were studied. Results The total patient-years(Pty) was737.24years. The INR value of17,643samples was1.99±0.56. The frequency of each patient21±11sample. The mean oral warfarin dosage was2.8±1.3mg.There were8deaths of which1death was related to anticoagulation therapy. There were130cases suffering mild bleeding whose INR value was2.78±1.25and4serious bleeding.There was1death due to intracranial hemorrhage which was not related to anticoagulation therapy. The total anticoagulation-related hemorrhage rate was18.0%Pty. The rate of mild bleeding was17.6%Pty. The rate of serious bleeding was0.4%Pty. There were10anticoagulation-related thromboembolism whose INR value was1.57±0.34. Among them were9cerebral infarction and1myocardial infarction. And1death was due to anticoagulation-related cerebral infarction. The total anticoagulation-related thromboembolism rate was1.4% Pty. The death rate of thromboembolism was0.14%Pty. Conclusion1. The most important complication of anticoagulation therapy after mechanical heart valve replacement is hemorrhage in china. Therefore, further reducing the anticoagulation intensity can prevent anticoagulation-related hemorrhage.2. It is beneficial to adopt the anticoagulation intensity (INR<2.5) for prevent hemorrhage. But INR value between groups of non-complication and thromboembolism is overlapping in the area of1.5-1.8. Our subsequent studies will illustrate whether we can reduce the anticoagulation intensity without increasing the rate of thromboembolism.3. It is helpful to prevent anticoagulation-related complication by the positive and proper anticoagulation monitoring after mechanical heart valve replacement.