Abstract
BackgroundInternational normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement. Several reviews and studies have demonstrated self-management as an option to improve patient’s outcome considerably after mechanical heart valve replacement. We sought to analyze the security, economy and discuss the prospect of self-testing of anticoagulation therapy in patients following mechanical heart valve replacement in China, and evaluate the accuracy and stability of CoaguChek XS portable INR-testing device.MethodsThis was a prospective self-controlled clinical study conducted with 526 patients receiving oral warfarin anticoagulation therapy after mechanical heart valve replacement in the period of Mar.1, 2012 – Nov.1, 2012 in Cardiovascular Surgery Department of West China Hospital of Sichuan University. The same patient performed INR testing with CoaguChek XS portable coagulometer (group1) and central lab (group 2) in parallel. The follow-up time was 6 months. Meanwhile, a questionnaire was handed out to survey the expenses required for the re-examination visits to the hospital, time, and anticoagulation complications.ResultsNo severe anticoagulation complications occurred in all the patients. No significant difference of the INR results were observed between group 1 and group 2, they showed significant relevance, r = 0.953(p < 0.05). Compared with the conventional method of INR testing in hospital, the portable coagulometer is convenient, quick and less traumatic. Self-testing of anticoagulation therapy reduced the cost and the time required for re-examination.ConclusionsResults of CoaguChek XS monitor are precise and have a good consistency and stability as compared with traditional laboratory testing. For the patients receiving anticoagulation therapy after mechanical heart valve replacement, the self-testing of anticoagulation therapy with portable coagulometer is a safe choice, and it has a promising future application in China.
Highlights
International normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement
There are 263 cases of mitral valve replacement (MVR) (50.0%), 91 cases (17.3%) of aorta valve replacement (AVR), 147 cases (27.9%) of mitral valve and aorta valve replacement (DVR), 12 cases (2.3%) of tricuspid valve replacement surgery (TVR), 9 cases (1.7%) of mitral valve and tricuspid valve replacement surgery (MVR + TVR), 4 cases(0.8%) of mitral valve and aorta valve with tricuspid valve replacement surgery (DVR + TVR)
We found that the patients with anticoagulation therapy in China knew little about portable coagulometer and were worried about this “new type” of monitoring instrument. 485 persons (92.2%) have never heard of portable coagulometer; 432 persons (82.2%) were worried that the measured value of the instrument itself or the measured value obtained by Anticoagulation complications Cerebral embolism Intracranial hemorrhage Thrombus formation Gum bleeding Nasal cavity bleeding Profuse menstruation Visible hematuria Total them may not be accurate; 146 persons (27.8%) thought that the instrument was too expensive; 333 persons (63.3%) worried about the adjustment of treatment regimen after self-monitoring
Summary
International normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement. Several reviews and studies have demonstrated self-management as an option to improve patient’s outcome considerably after mechanical heart valve replacement. We sought to analyze the security, economy and discuss the prospect of self-testing of anticoagulation therapy in patients following mechanical heart valve replacement in China, and evaluate the accuracy and stability of CoaguChek XS portable INR-testing device. Chen et al Journal of Cardiothoracic Surgery warfarin It has the advantage of accurate measurement which gives the patient professional guidance on anticoagulation after testing. Such re-examination visits are costly and time-consuming. Low frequency of monitoring may obviously affect the anticoagulation therapy management, increasing the incidence of complications, and greatly increase the risks of anticoagulation therapy [7,8]
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