title: INR self-management following mechanical heart valve replacement.
abstract: INR self-management can reduce severe thromboembolic and hemorrhagic complications following mechanical heart valve replacement. Beginning anticoagulation therapy immediately in the postoperative period further reduces anticoagulant-induced complications. Data were collected from the first 600 surviving patients (from a total study sample of 1200 patients) who completed follow-up of at least 2 years. Patients were randomly divided into a self-management group and a control group. INR self-management reduced severe hemorrhagic and thromboembolic complications (P=0.018). Nearly 80% of INR values recorded by patients themselves, regardless of educational level, were within the target therapeutic range of INR 2.5-4.5, compared with 62% of INR values monitored by family practitioners. Only 8.3% of patients trained in self-management immediately after surgery were unable to continue with INR self-management. The results differed slightly between patient groups with different levels of education. We conclude that all patients for whom anticoagulation is indicated are candidates for INR self-management regardless of education level.
authors.affiliation: Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Koertke
authors.forename: K
authors.initials: K
authors.lastname: Minami
authors.forename: A
authors.initials: A
authors.lastname: Bairaktaris
authors.forename: O
authors.initials: O
authors.lastname: Wagner
authors.forename: R
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods*; D010346:Patient Care Management; D010349:Patient Compliance; D010353:Patient Education as Topic; D012646:Self Administration; D013923:Thromboembolism / Q000517:prevention & control; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D000925:Anticoagulants