Evaluation Of Intensity Of Anticoagulant Therapy After Mechanical Valve Replacement

Objectives:To determine the anticoagulant intensity target suitable for patients after mechanical valve replacement in Yan ’an area.This standard of low-intensity anticoagulant therapy can not only prevent thromboembolism,but also reduce the incidence of anticoagulation-related bleeding complications.Method:This study retrospectively collected from January 2014-December 2021 in yan ’an university hospital Dongguan cardio-cerebrovascular disease hospital cardiovascular surgical residents line of artificial mechanical valve replacement patients data,all patients with postoperative taking warfarin anticoagulant therapy and periodically review,collect and analyze its warfarin therapy and anticoagulation intensity,Objective International standardized ratio（INR）was selected as the analysis index of anticoagulant therapy intensity,warfarin dose adjustment strategy was selected as the treatment plan every week,and the incidence of valvular disease anticoagulation-related complications were followed up.According to its INR grouping,relatively low anticoagulation intensity group of patients with higher anticoagulation intensity between the group of patients with gender,age,LVEF,cardiac function,factors related to the operation,blood coagulation indexes and anticoagulant therapy,valvular disease,anticoagulation event related situation,the indicators of count data with χ ^ 2 or Fisher exact generalized method of inspection,T test was used for measurement data analysis,rank sum test was used for grade data,P <0.05 was statistically significant,and there was no difference between high and low anticoagulant treatment intensity groups.Results: A total of 50 patients with valvular disease who underwent mechanical valve replacement were enrolled in this study.All patients received warfarin anticoagulant therapy in accordance with the doctor’s advice.Mitral valve replacement was performed in 22 cases（44%）,aortic valve replacement in 15 cases（30%）,and combined mitral valve replacement in 13 cases（26%）.1.As shown in Table 1,there was no significant difference in gender,age,LVEF and other indicators between patients in the lower anticoagulant intensity group and those in the higher anticoagulant intensity group.（P>0.05）.2.As shown in Table 2,there was no statistically significant difference in surgical methods,extracorporeal circulation time,aorta blocking time and other surgically related indicators between patients in the lower anticoagulant intensity group and those in the higher anticoagulant intensity group（P>0.05）.3.As shown in Table 3,there was statistically significant difference in coagulation function between patients in the lower anticoagulant intensity group and those in the higher anticoagulant intensity group（P<0.05）.4.As shown in Table 4,the comparison of complications of valvular disease anticoagulant therapy between patients in the lower anticoagulant therapy intensity group and patients in the higher anticoagulant therapy intensity group showed statistically significant differences in the occurrence of bleeding related complications（P<0.05）.Conclusion:In the absence of risk factors related to coagulation complications after mechanical valve replacement in Yan ’an area,the risk of embolization complications will not be increased when the target INR value is controlled between 1.5 and 2.0.The low intensity anticoagulant therapy regimen improved the coagulation function of the patients after mechanical valve replacement compared with the control group.If appropriate,adjusting the medication regimen with reference to this lower intensity standard can appropriately prolong the review period and reduce the costs related to anticoagulant therapy for patients.