THROMBOTIC AND HEMORRHAGIC COMPLICATIONS IN PATIENTS WITH MECHANICAL HEART-VALVE PROSTHESIS ATTENDING AN ANTICOAGULATION CLINIC

This study evaluated the advantage of an anticoagulation clinic in ter ms of the improvement of the clinical quality of oral anticoagulation (i. e. prevention of thromboembolism and low rate of hemorrhagic compl ications). The incidence of thromboembolic events and major hemorrhagi c complications was assessed in a series of 271 patients on oral antic oagulation for mechanical heart valve prosthesis before and after thei r enrollment in our anticoagulation clinic from January 1987 to Decemb er 1990. Risk factors for hemostatic events were also analyzed. The in cidence of major hemostatic complications was significantly lower when patients attended the clinic: 1.0 vs 4.9%/pt-yr for hemorrhage and 0. 6 vs 6.6%/pt-yr for thrombosis. This depended on three main factors: b etter dose regulation of warfarin, continuous patient education and ea rly identification of clinical conditions potentially at risk for thro mbosis and hemorrhage. Only previous hemorrhagic or thromboembolic eve nts were recognized as major risk factors for hemostatic complications . In conclusion, our study shows that an anticoagulation clinic offers a real advantage to patients with mechanical heart valve prosthesis i n terms of prevention of thromboembolic events and hemorrhagic complic ations.