Anticoagulation early after mechanical valve replacement: Improved management with patient self-testing

Thompson, Jess L.; Burkhart, Harold M.; Daly, Richard C.; Dearani, Joseph A.; Joyce, Lyle D.; Suri, Rakesh M.; Schaff, Hartzell V.

doi:10.1016/j.jtcvs.2012.03.088

Cited by 27 publications

(50 citation statements)

References 23 publications

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“…subjects with the CYP2C9*1/*1 genotype, was 75.4% and was even higher or similar to those reported previously, mostly for AF patients [13,19,20]. This highlights the good quality of warfarin therapy in Polish patients after valve implantation, which indicates a large improvement in TTR values in everyday practice nowadays, although compared to countries with the best quality of anticoagulation, e.g.…”

Section: Discussionsupporting

confidence: 84%

“…Similarly, previous studies in a large cohort of patients mostly with AF and after mechanical heart valve implantation have shown no differences in frequency of the first stroke, major bleeding complications and death between the selftesting and standard-care group [24]. However, better TTR has been achieved in the self-testing group than the standard care group [19,24]. We did not find these associations probably due to the limited size of our study group.…”

Section: Discussionsupporting

confidence: 56%

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CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients Within the First 3 Months Following Heart Valve Replacement

et al. 2015

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Background. Warfarin dose requirements are partly determined by common single nucleotide polymorphisms in VKORC1 and CYP2C9 genes. Objectives. The aim of this study was to investigate how the presence of allelic variants in CYP2C9 affects the stability of anticoagulation in patients within the first 3 months following elective heart valve replacement. Material and Methods. In a case-control study we compared 18 consecutive carriers of CYP2C9*2 and/or *3 and 25 well-matched patients with the wild type CYP2C9*1/*1 genotype. The former group was randomly assigned to use coagulometers or monitor international normalized ratio (INR) in local outpatient clinics. Subjects receiving drugs potently interfering with warfarin were ineligible. Anticoagulation with the baseline warfarin regimens based on pharmacogenetic algorithm was assessed by time in the therapeutic INR range (TTR) within the first 3 months following implantation. Results. Carriers of the CYP2C9*2 and/or *3 genotypes were characterized by lower estimated warfarin dose (median, 21 [interquartile range, 21-35] vs. 35 [28-42] mg/week, p = 0.02) and actual (27.8 ± 13.2 vs. 46.3 ± 13.9 mg/week, p < 0.001), together with lower TTR values (56 [38.6-74.9] vs. 75.4 [58.1-83.6] %, p = 0.03) and longer time above the therapeutic range (13.8 [4.9-34.5] vs. 4.5 [0-15.3] %, p = 0.047) than patients with the CYP2C9*1/*1 genotype. There were no differences in the estimated and actual warfarin doses, TTR values and adverse events between the self-testing and standard-care subgroups. Conclusions. The presence of CYP2C9*2 and/or *3 genotypes is associated with unstable warfarin treatment in patients after heart valve replacement, regardless of the type of INR testing (Adv Clin Exp Med 2015, 24, 4, 607-614).

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 56%

CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients Within the First 3 Months Following Heart Valve Replacement

et al. 2015

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“…These studies were conducted between 1998 and 2016. Four studies were conducted in the Denmark (18,22,26,39); fourteen in Germany (21, 23, 28-34, 36, 37, 40-42); two in the United States (20,25); one, in China (35); one, in France (27); one, in Netherlands (38); one, in Northern Ireland (19) and one, in South Korea (24). (See Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…(26,28). Self-management in these patients requires taking a blood sample using a puncture nger and analyzing it by the patient himself, which must be taught the correct method and principles of hygiene (20,25), also these patients should be trained in such things as vitamin K antagonists, diet, Drug Interactions, methods of control INR outside the target range, precautions in the use of anticoagulants, complications of medications, surgical wound management, alcohol consumption, use of narcotics, daily life, exercise and physical activity, stress management and ways to communicate with the hospital (21,24,27).…”

Section: Discussionmentioning

confidence: 99%

“…Qiu-lin Chen et al have stated that for patients receiving anticoagulation therapy after mechanical heart valve replacement, the self-testing of anticoagulation therapy with a portable coagulometer is a safe choice, and it has a promising future that reduced the cost and the time required for re-examination(35). Thompson, J. L et al Shown that Management of anticoagulation with warfarin after mechanical valve replacement is improved with self-testing, even during the early postoperative phase when international normalized ratio testing is performed frequently(25). Jess L. Thompson et al study reported that the mean INR test result obtained from the coagulometer and by self-testing correlated well with the values obtained by laboratory determination(20).…”

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confidence: 99%

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Self-Management in Patients with Heart Valve Replacement and Its Clinical Outcomes: A Systematic Review

Zandi

Imani

Khazaei

et al. 2020

Preprint

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Background: For patients with heart valve replacement, self-management can play an important role in controlling the patient's condition, therefore, the purpose of this review was to identify the aspects of self-management and its clinical outcomes in patients with heart valve replacement. Methods: We conducted a systematic review of peer-reviewed research literature focused on self-management in patients with heart valve replacement. The databases of PubMed, Scopus, and web of science were searched until May 2020 free from time and language limitation. Al documents were assessed for eligible articles by title or abstract according to the search strategy.The screening process of articles was conducted by two independent authors. The selected articles were checked regarding to inclusion and exclusion criteria.Results: Finally, 25 studies were considered in this systematic review. Self-management of these patients has prerequisites and requires appropriate training. Self-management in these patients is applicable in the aspects of Anticoagulation therapy self-management, INR self-testing, Low-dose INR Self-management, and Heart valve function self-monitoring. In this method, with better control of INR levels and Anticoagulation therapy, the incidence of complications will be reduced and patients will be able to diagnose functional disorders in the early stages by monitoring the function of valve, which will prevent the progression of complications. Conclusion: The results of this review clearing that self-management is applicable in the aspects of Anticoagulation therapy, INR control, low dose INR management, and monitoring of cardiac valve function and by improving care standards, it will improve the quality of treatment for these patients.

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Self-monitoring and self-management of oral anticoagulation

Heneghan

García-Alamino

Spencer

et al. 2016

Cochrane Database of Systematic Reviews

128

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Anticoagulation early after mechanical valve replacement: Improved management with patient self-testing

Cited by 27 publications

References 23 publications

CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients Within the First 3 Months Following Heart Valve Replacement

CYP2C9 Polymorphism and Unstable Anticoagulation with Warfarin in Patients Within the First 3 Months Following Heart Valve Replacement

Self-Management in Patients with Heart Valve Replacement and Its Clinical Outcomes: A Systematic Review

Self-monitoring and self-management of oral anticoagulation

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