Anticoagulation early after mechanical valve replacement

Improved management with patient self-testing

Jess L. Thompson, Harold M. Burkhart, Richard C. Daly, Joseph A. Dearani, Lyle D. Joyce, Rakesh M. Suri, Hartzell V Schaff

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: Self-testing to determine the international normalized ratio improves management with warfarin and reduces the risks of adverse events. Self-testing usually begins several weeks after hospital dismissal after valve replacement. We aimed to compare the in-hospital initiation of international normalized ratio self-testing with usual care in mechanical heart valve recipients. Methods: A total of 200 adult mechanical heart valve recipients were randomly assigned to in-hospital international normalized ratio self-testing instruction or usual care. Instruction for self-testing patients began on the fourth postoperative day. The patients were followed up for 3 months to compare the number of international normalized ratio tests, percentage of time in the therapeutic range, and adverse events. Results: The baseline characteristics were similar between the 2 groups. During the first 3 postoperative months, the usual-care group underwent an average of 10 international normalized ratio tests, and the self-testing group completed 14 international normalized ratio tests. The mean ± SD percentage of international normalized ratio tests within the therapeutic range was 45% ± 22% for the usual-care group and 52% ± 22% for the self-testing group (P =.05). Within 90 days after dismissal, transient ischemic attack occurred in 1 patient in the usual-care group and 2 patients in the self-testing group. Bleeding complications occurred in 3 patients in the usual-care group and 5 patients in the self-testing group. Conclusions: Management of anticoagulation with warfarin after mechanical valve replacement is improved with self-testing, even during the early postoperative phase when international normalized ratio testing is performed frequently. Although the incidence of adverse events was similar in the 2 groups, better control of the international normalized ratio would be expected to improve outcome in large populations of patients.

Original languageEnglish (US)
Pages (from-to)599-604
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume146
Issue number3
DOIs
StatePublished - Sep 2013

Fingerprint

International Normalized Ratio
Heart Valves
Warfarin
Transient Ischemic Attack
Hemorrhage
Control Groups
Incidence

Keywords

  • INR
  • international normalized ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Anticoagulation early after mechanical valve replacement : Improved management with patient self-testing. / Thompson, Jess L.; Burkhart, Harold M.; Daly, Richard C.; Dearani, Joseph A.; Joyce, Lyle D.; Suri, Rakesh M.; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 146, No. 3, 09.2013, p. 599-604.

Research output: Contribution to journalArticle

Thompson, Jess L. ; Burkhart, Harold M. ; Daly, Richard C. ; Dearani, Joseph A. ; Joyce, Lyle D. ; Suri, Rakesh M. ; Schaff, Hartzell V. / Anticoagulation early after mechanical valve replacement : Improved management with patient self-testing. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 146, No. 3. pp. 599-604.
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abstract = "Objective: Self-testing to determine the international normalized ratio improves management with warfarin and reduces the risks of adverse events. Self-testing usually begins several weeks after hospital dismissal after valve replacement. We aimed to compare the in-hospital initiation of international normalized ratio self-testing with usual care in mechanical heart valve recipients. Methods: A total of 200 adult mechanical heart valve recipients were randomly assigned to in-hospital international normalized ratio self-testing instruction or usual care. Instruction for self-testing patients began on the fourth postoperative day. The patients were followed up for 3 months to compare the number of international normalized ratio tests, percentage of time in the therapeutic range, and adverse events. Results: The baseline characteristics were similar between the 2 groups. During the first 3 postoperative months, the usual-care group underwent an average of 10 international normalized ratio tests, and the self-testing group completed 14 international normalized ratio tests. The mean ± SD percentage of international normalized ratio tests within the therapeutic range was 45{\%} ± 22{\%} for the usual-care group and 52{\%} ± 22{\%} for the self-testing group (P =.05). Within 90 days after dismissal, transient ischemic attack occurred in 1 patient in the usual-care group and 2 patients in the self-testing group. Bleeding complications occurred in 3 patients in the usual-care group and 5 patients in the self-testing group. Conclusions: Management of anticoagulation with warfarin after mechanical valve replacement is improved with self-testing, even during the early postoperative phase when international normalized ratio testing is performed frequently. Although the incidence of adverse events was similar in the 2 groups, better control of the international normalized ratio would be expected to improve outcome in large populations of patients.",
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