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European Journal of Cardio-Thoracic Surgery, Vol 11, 935-942, Copyright © 1997 by European Association for Cardio-thoracic Surgery
JM Hasenkam, HH Kimose, L Knudsen, H Gronnesby, J Halborg, TD Christensen, J Attermann and HK Pilegaard
OBJECTIVE: Patients with mechanical heart valves require lifelong oral
anticoagulant treatment which entails frequent blood sampling and dosage
adjustment. The purpose of this study was to investigate the feasibility of
letting heart valve operated patients manage blood specimen analysis and
dosage adjustment themselves. METHODS: A total of 21 patients were enrolled
in the study and followed for at least 9 months postoperatively.
Immediately after the heart valve operation they were trained in operating
a CoaguChek international normal ratio (INR) monitor to analyze capillary
whole blood samples. Subsequently training in dosage adjustment was
accomplished and all patients were considered fully capable of self
management after 30 weeks. In the training period, parallel laboratory INR
measurements were made at 3-4 week intervals for reference. A control group
of 20 patients was matched, respectively, to the study group. The INR
target range was 2.0- 3.0. RESULTS: Out of the 21 study patients 19
continued self management beyond 9 months. The median INR value obtained
with the monitor was within therapeutic target range for all study patients
and only 15 out of 20 control patients were within this range. The mean
systematic deviation between laboratory and CoaguChek INR was 7.8% but each
patient had a constant characteristic deviation from -11 to +21%. The study
patients were within therapeutic target range 77% of the time compared with
53% for the control patients. CONCLUSIONS: Self management of oral
anticoagulation is feasible for selected patients and constitutes a
significant service improvement compared with conventional management. The
CoaguChek monitor seems sufficiently accurate and reliable for self testing
and the treatment quality is comparable or even better than conventional
management. Assessment of the rate of bleeding and thrombo-embolic events
shall be settled in studies comprising larger number of patients.
ARTICLES
Self management of oral anticoagulant therapy after heart valve replacement
Department of Cardiothoracic and Vascular Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus N, Denmark. skejmh@aau.dk
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