title: Mechanical heart valve patients can manage oral anticoagulant therapy themselves.
abstract: OBJECTIVE
  Thromboembolism and anticoagulant related bleeding are still the most common complications in mechanical heart valve patients. Management of the oral anticoagulant therapy is therefore a key determinant for these clinical complications. We hypothesize that patients selected to self-managed oral anticoagulant therapy have a better treatment quality than patients in conventional oral anticoagulant therapy. The aim of this study was to assess the time within the therapeutic International Normalized Ratio (INR) target range and the incidence of clinical complications in our group of patients, and compare these data with published data on conventional management.
  
  
  METHODS
  Mechanical heart valve patients (N=94) with a mean age of 47.6 years (range 4.2-76.6 years) were trained in home blood analysis of INR using a CoaguChek home coagulometer and coumarin dosage adjustment. After training, the patients were followed by weekly INR measurements. The therapeutic range was a target INR +/-0.5. The indications for initiating oral anticoagulant therapy were: aortic valve (N=62), mitral valve (N=29), tricuspid valve (N=1) and multiple valves (N=2).
  
  
  RESULTS
  The mean observation time was 2.1 years (range 0.04-6.2 years), and the total number of patient-years was 197. The patients were within the therapeutic INR target range for a median of 76.0% (range 32.1-100.0%) of the time. There were two major thromboembolic events and five major bleedings events, comprised of two deep vein thromboses (both in the same patient), four episodes of epistaxis and one case of gastrointestinal bleeding. All the events required short hospitalization, and after treatment all the patients were discharged from the hospital without any sequelae or other complications. Using published work as references the expected number of major thromboembolic and bleeding complications in conventional management was four and 12, respectively.
  
  
  CONCLUSIONS
  Self-management of oral anticoagulant therapy provides a good treatment quality for mechanical heart valve patients. We therefore consider self-management of oral anticoagulant therapy as an equally as good or potentially better treatment option for selected patients compared to conventional management.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery and Institute of Experimental Clinical Research, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark. t.d.christensen@iefk.au.dk
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Christensen
authors.forename: Niels T
authors.initials: NT
authors.lastname: Andersen
authors.forename: Jørn
authors.initials: J
authors.lastname: Attermann
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
authors.forename: Marianne
authors.initials: M
authors.lastname: Maegaard
authors.forename: J Michael
authors.initials: JM
authors.lastname: Hasenkam
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012646:Self Administration; D012648:Self Care; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants