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
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.