The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

Abstract

Introduction: Although, the effects of patient education on the effective anticoagulant management, among patients undergoing heart valve replacement with a mechanical prosthesis, have been reported, the evidence of this association remains inconclusive. Aim: To investigate the effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement. Methods: A quasi-experimental study was conducted. Patients were allocated to a) a control group (n=100), including those who received the usual education on oral anticoagulants, and b) an intervention group (n=100), with those who attended a nurse-led education program, postoperatively, including verbal courses and written material through an education booklet. We investigated the incidence of hemorrhagic and thromboembolic episodes three months after patients' hospital discharge. Patients' socio-demographic and clinical characteristics were obtained using a structured short questionnaire and through the medical and nursing patient records review. Patients' follow-up data were collected via phone interviews. Results: The baseline characteristics were similar for both groups. Patients who received nurse-led education on oral anticoagulant therapy had a significantly lower 3-month incidence of hemorrhagic episodes compared with controls (1% vs. 14%, p<0.001). However, we found insignificant differences in the 3-month incidence of thromboembolic events between the two groups. Conclusion: The implementation of a nurse-led education program on oral anticoagulants management failed to show effectiveness on the 3-month incidence of thromboembolic episodes. However, this educational intervention seems to be superior to the general patient education, leading to the significantly lower occurrence of hemorrhagic episodes.

La ricerca finalizzata in Area Medica: approfondimenti assistenziali dell’Associazione A.N.Í.M.O.

“…La scelta deve tenere in considerazione le preferenze del paziente. (78) Gli interventi educativi circa la gestione degli anticoagulanti orali devono essere specifici per il tipo di farmaco prescritto. (76) È importante educare il paziente ad informare il personale sanitario circa il fatto che sta assumendo una terapia con anticoagulanti orali.…”

“…Nel valutare un paziente in terapia con warfarin, per valutare la sicurezza del trattamento, è necessario anche tener conto dell'aderenza terapeutica. (78) Nel processo di valutazione del paziente è indispensabile considerare e verificare la comprensione dell'importanza di una dieta adeguata e regolare. (76) Le vecchie raccomandazioni di una dieta a basso contenuto di vitamina k dovrebbero essere considerate obsolete.…”