Self-management of anticoagulation therapy after mechanical heart valve replacement –10 years experience of a single center

Objectives: Oral anticoagulation (OA) requires frequent blood-checks and dose-changes to prevent thromboembolic or hemorrhagic complications after mechanical heart valve (MHV) replacement. We hypothesize that quality of OA and long-term outcome of patients with self-management of OA (group 1) is superior to conventional anticoagulation treatment (group 2).

Material and Methods: Between 1993 and 1998 124 patients with MHV, age: 62±10 years (aortic-valve replacement (AVR): n=97, mitral-valve replacement (MVR): n=10, double-valve replacement (DVR): n=17) were trained in INR-home-assessment using portable coagulometers and OA dose-adjustment according their therapeutic-range (group 1). This group was compared to 174 patients, age: 67±8 years (p<0.001) (AVR: n=155, MVR: n=4, DVR: n=15) with OA-management by family physicians (group 2).

Results: Follow-up time was 8.6 2.1 years representing 2457 patient-years. In the last 12 months patients of group 1 measured their OA 4.1/month vs. group 2 1.9/month (p<0.01) and were within the therapeutic range for a median of 73% (range 12–100%) vs. group 2 in 59% (range 9–100%; p<0.001). During follow-up 44% (n=53) of group 1 had bleedings and 9.5% (n=12) had thromboembolic events vs. group 2 had 38.5% (n=60) bleedings (p=0.39) and 13.8% (n=24) thromboembolic events (p=0.20). Serious adverse events with the need of treatment or hospitalization were lower in group 1 (6 bleedings and 2 thromboembolisms vs. 14 and 9, respectively (p=0.06). Patients with self-management where significantly more satisfied with OA (p<0.001). During follow-up 21 patients died (8 cardiac, 2 major bleedings, 5 non-cardiac, 6 not-stated).

Conclusions: Self-management of OA improves long term outcome and treatment quality for patients with MHV. We therefore offer this treatment strategy to every patient after MHV replacement.