International normalized ratio self-management after mechanical heart valve replacement: Is an early start advantageous?

Citation
H. Kortke et R. Korfer, International normalized ratio self-management after mechanical heart valve replacement: Is an early start advantageous?, ANN THORAC, 72(1), 2001, pp. 44-48
Citations number
14
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Journal title
ANNALS OF THORACIC SURGERY
ISSN journal
00034975 → ACNP
Volume
72
Issue
1
Year of publication
2001
Pages
44 - 48
Database
ISI
SICI code
0003-4975(200107)72:1<44:INRSAM>2.0.ZU;2-K
Abstract
Background. Severe thromboembolic and hemorrhagic complications after mecha nical heart valve replacement essentially depend on the intensity of oral a nticoagulation and the fluctuation of individual international normalized r atio (INR) values. Methods. After heart valve replacement with Medtronic Hall, St. Jude Medica l, and CarboMedics implants, patients were randomly divided into two groups , one controlling INR values at home, the other being monitored by family p ractitioners. Results. Almost 80% of the INR values recorded by patients at home were wit hin the stipulated therapeutic range, INR 2.5 to 4.5, compared with just 62 % of INR values recorded by family practitioners. The overall complication rate (hemorrhages and thromboembolic events) of the self-management group w as significantly (p < 0.05) decreased compared with the conventional group. Conclusions. Through INR self-management, an improvement in the quality of ongoing oral anticoagulation could be shown. Starting this form of therapeu tic control early after mechanical heart valve replacement appears to effec t a further reduction in anticoagulant-induced complications. (C) 2001 by T he Society of Thoracic Surgeons.