Feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions

Abstract

Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions. Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin, including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group). The patients were followed up for 12 months after operation; the rate of anticoagulation efficacy, the anticoagulation-related complications, and the anticoagulation-related cost were documented and compared between two groups. Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 %, 717/1 021), while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3%, 688/965); there were no significantly differences in efficacy rate between two groups (P>0.05). There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5% (13/79) vs. 12.2% (10/82), 6.3%(5/79) vs. 4.9%(4/82), respectively, χ2=0.596, P=0.44, χ2=0.161, P=0.69]. The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1±12.8) vs. (176.6±16.4) yuan, t=48.716, P<0.05]. Conclusion Compared with the tertiary hospital, the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement. Key words: Heart valve prothesis implantation; Warfarin; Anticoagulation therapy; Hospitals, general; Hospitals, community