| Background: Oral warfarin therapy is widely used as an antithrombotic therapy for patients with cardiovascular disease,especially after surgery.Due to the narrow treatment window for warfarin,all patients receiving warfarin anticoagulation must have their blood clotting indicators tested regularly and their dosages adjusted to maintain their INR within the target range.The anticoagulant management model based on INR selfdetection and remote follow-up has been applied to warfarin treatment of patients after cardiac valve replacement.However,the effectiveness and safety of this remote management model and traditional hospital-clinic anticoagulant management model have not been evaluated.Objective: In this study,we compared the coagulation indexes,complications and anticoagulation costs of patients receiving INR self testing and remote follow-up anticoagulation management model with those receiving hospital outpatient anticoagulation management model after valve replacement,and analysis the differences and similarities of the safety and effectiveness of the two models.Methods: This study was a retrospective,observational cohort study,including 79 patients who underwent heart valve replacement surgery in our hospital from October 2018 to October 2020 and regularly received oral warfarin anticoagulant therapy 6 months or more after discharge according to inclusion and exclusion criteria.Patients were divided into remote management group（n = 40）and outpatient management group（n = 39）according to their will（n = 39）.All INR,total number of tests,bleeding and thromboembolic events,deaths,warfarin-related rehospitalization,and anticoagulant management expenses were analyzed in the two groups within 6 months.SPSS 24.0 software was used for statistical analysis.Chi-square test or Fisher’s exact probability method was used for counting data,and T-test or Mann-Whitney rank-sum test was used for measuring data.Results:（1）General data: in the remote management group,55% were female,with an average age of 41.75±4.41 years,and 12 and 14 patients underwent mitral or aortic valve replacement,respectively;In the outpatient management group,women accounted for 48.72%,with an average age of 44.49±11.26 years,and 9 and 14 patients underwent mitral or aortic valve replacement,respectively.There were no significant differences in gender,age and surgical methods between the two groups.In addition,there were no significant differences in residence type,education level,annual income level,cardiac function grade,underlying diseases,primary diseases,previous smoking or drinking status and BMI between 2 groups（P > 0.05）.（2）Coagulation index and complications: INR of 2 groups were 2.20±0.69 and 2.13±0.63,respectively,with no statistical difference（P=0.295）.The time in therapeutic rang（TTR）of the remote management group and the control group were 43.05%,27.49%,and the fraction in therapeutic range,respectively.FTTR were 45.81% and 29.30%,respectively,and the differences were statistically significant（P < 0.05）.None of the patients had severe bleeding or thromboembolism events during the study follow-up period.7 patients in the remote management group reported minor bleeding events such as nasal bleeding,while 11 patients in the outpatient management group reported similar events,with no statistical significance（P > 0.05）.（3）Patients in the remote management group performed better in terms of total test frequency and satisfaction,with statistical differences（P < 0.001）.However,the anticoagulation-related expenditure of patients in the outpatient management group was （?）339.33±99.64,which was lower than that in the remote management group,and the difference was statistically significant（P < 0.001）.Conclusions: This study shows that the application of anticoagulation management model based on portable clotting instrument and telemedicine can significantly improve the frequency of INR detection and help maintain more stable INR,and the incidence of warfarin complications during the follow-up period is not high,the cost of anticoagulation therapy is acceptable,and the satisfaction of patients is higher.Therefore,for eligible patients after cardiac valve replacement,remote anticoagulant management model to manage warfarin therapy is safe and more effective than traditional outpatient anticoagulant management model. |
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