Abstract
To assess advantages of integrated approach to improvement of efficiency and safety of warfarin therapy after heart valve replacement. We included in this study 118 patients who had undergone simultaneous mitral valve replacement and maze procedure. Group 1 patients (n=37) underwent just sinus rhythm restoration, group 2 patients (n=54) underwent sinus rhythm restoration and participated in a patient education program, group 3 patients (n=27) underwent sinus rhythm restoration, participated in a patient education program, and were subjected to pharmacogenetic testing for warfarin sensitivity. In examination of patients we used clinical, demographic, and instrumental methods. Estimation of the time in the therapeutic range (TTR) of an international normalized ratio (INR) was used as a measure of warfarin therapy quality, and the Kaplan-Meier method was applied for analysis of hemorrhagic and thrombotic complications. TTR was 42 % in group 1, 68 % in group 2 (p=0.0327), and 82 % in group 3 (p=0.0019). Application of integrated approach was associated with absence of hemorrhagic and thrombotic complications within one year after heart valve replacement. The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications.
Highlights
We included in this study 118 patients
the Kaplan-Meier method was applied for analysis
Application of integrated approach was associated with absence
Summary
The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications. Но не исключает возможность рецидива фибрилляции предсердий (ФП), устранение которой является перво- Материал и методы очередной задачей достижения эффективности и безо- В исследование были включены 118 пациентов после пасности антикоагулянтной терапии (АКТ) у пациентов одномоментной коррекции порока МК и процедуры с протезированными клапанами сердца (ПКС) [7,8,9]. Именно этих факторов направлена обучающая программа Сравниваемые группы не имели статистически знадля пациентов – организационная форма реабилитацион- чимых различий по полу, возрасту, основному диагнозу, ных мероприятий, главной целью которой является повы- ставшему причиной порока сердца, и выраженности хрошение информированности, приверженности к лечению, нической сердечной недостаточности, типу протеза клаулучшение качества и прогноза жизни [12,13,14]. В предыдущих работах оценивалась эффективность В исследовании применяли стандартные инструстратегии последовательного восстановления СР [15], ментальные методы: электрокардиографию (ЭКГ)
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