Comparative Study Of Two Different Anticoagulant Intensities After Cardiac Valve Replacement

Objective:Through the follow-up study on the anticoagulant intensity and anticoagulation-related complication of patients after cardiac mechanical valve replacement,we provide a basis for the development of safe and effective anticoagulation standard after mechanical valve replacement in China,and provide reference for clinical anticoagulation therapy.Methods:According to the strict inclusion criteria,We selected 162 patients who were treated with warfarin anticoagulation after cardiac valve replacement in the Department of Cardiothoracic Surgery at the First Hospital of Shanxi Medical University from January 2014 to October 2016.We followed the postoperative anticoagulant intensity and anticoagulation-related complications.According to the level of anticoagulant strength,the subjects were divided into A and B groups.Through statistical analysis,we can know whether there is a difference aboat the incidences of anticoagulant related complications between group A and group B.By statistically analyzing the anticoagulant strength of patients without complications,we obtained a safe and effective range of anticoagulant strength.Results:The patients were followed up for a maximum of 34 months and a shortest period of 3 months.A total of 162 patients were enrolled.A total of 11 cases(6.79%)were bleeding,including 1 case(0.62%)of cerebral hemorrhage,1 case of gastrointestinal bleeding,3 cases of epistaxis,Bleeding in 6 cases;A total of 3 cases(1.85%)were thromboembolism,including cerebral infarction in 1 case,right lower limb arterial embolism in 2 cases.There were 103 cases of A group,including 2 cases(1.94%)of hemorrhage and 3 cases(2.91%)of thromboembolism,There were 59 cases of B group,including 9 cases(15.25%)of hemorrhage and 0 cases(0.00%)of thromboembolism.There was Statistical differences in PT and INR between A group and B group(P<0.05).The incidence of anti-coagulation-related complications in group A was lower than that in group B(P <0.05).The incidence of bleeding complications in group A was lower than that in group B(P <0.05).There was no Statistical difference in the incidence of thromboembolic complications between A group and B group(P >0.05).There was no Statistical difference in the incidence of anticoagulation-related complications between A group and B group after mitral valve replacement(P> 0.05),The incidence of anticoagulation-related bleeding in group A was lower than that in group B(P<0.05),but the incidence of anticoagulant-related thrombosis was not statistically different(P>0.05).There was no Statistical difference in the incidence of anticoagulation-related complications among mitral valve replacement,aortic valve replacement and double valve replacement(P>0.05).The safe range of PT for anticoagulation therapy was 19.32 ~ 26.6s and the safety range of INR was 1.55 ~ 2.2 after mechanical heart valve replacement.conclusion:Lower intensity anticoagulant therapy after mechanical heart valve replacement can reduce the incidence of bleeding and do not increase the thromboembolism rate,so lower intensity anticoagulant therapy is feasible.In this study,the safe range of PT for anticoagulation therapy was 19.32 ~ 26.6s and the safety range of INR was 1.55 ~ 2.2 after mechanical heart valve replacement.