Effect of post-operative anticoagulation management in patients who have undergone On-X mechanical heart valve replacement surgery on post-discharge warfarin therapy

Abstract

What is known and objective We evaluated the effect of the proportion of time maintained within the target international normalized ratio (INR) postoperatively in hospitalized patients who underwent On-X mechanical heart valve replacement on warfarin therapy after discharge. Methods Inclusion was patients who were >= 18 years, received warfarin for a minimum of 10 days without any interruptions during hospitalization and followed by the anticoagulation service (ACS) clinic after discharge between June 2006 and June 2016. Patients were excluded if they had incomplete medical records, INR goal changes, known as warfarin resistance, transferred to another facility or expired during the study. The patients were divided into 3 groups according to the proportion of time maintained within therapeutic INR range (TTR) from day 4 to 10 of warfarin initiation (low: <30%, moderate: >= 30% to <70%, and high: >= 70%). The number of days needed to reach target INR for 2 consecutive measurements after discharge and the number of ACS visits was compared among the groups. Results and discussion Among 539 postoperative patients, 273 were included. The baseline demographics were similar among the 3 groups. The mean time needed to reach target INR for 2 consecutive measurements was 68.6 +/- 106.1 days. The low group required time needed to reach target INR for 2 consecutive measurements of 94.0 +/- 140.9 days compared with 44.8 +/- 57.1 days in the high group (P = .007). Additionally, the low group had more ACS visits than the high group (low, 6.6 +/- 5.2 vs high, 4.6 +/- 3.9; P = .025). Patient compliance affected the time needed to reach target INR for 2 consecutive measurements (compliant, 42.36 +/- 58.5 days vs non-compliant, 132.0 +/- 157.1 days, P < .001). What is new and conclusion The study implicated that high postoperative TTR would reduce the time to require post-discharge target INR and the number of ACS visits.