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An audit of anticoagulation and endocarditis prophylaxis after heart valve surgery
1Christchurch School of Medicine.
Insights
Improving patient education on anticoagulant control and endocarditis prophylaxis after heart valve surgery can reduce long-term complications. Broader antibiotic prophylaxis for dental procedures is also recommended for these patients.
Area of Science:
- Cardiology
- Surgical Outcomes
Background:
- Heart valve surgery requires careful management of anticoagulation and endocarditis prophylaxis.
- Long-term complications can arise from inadequate control and prophylaxis.
Purpose of the Study:
- To audit anticoagulant control and endocarditis prophylaxis in patients post-heart valve surgery.
- To determine the incidence of endocarditis and anticoagulation complications.
Main Methods:
- Retrospective review of 190 patients undergoing heart valve surgery (1981-1986).
- Assessed incidence of endocarditis and complications of anticoagulation.
Main Results:
- Late complications included thromboembolism (3), major bleeding (2), and endocarditis (4).
- Rates: thromboembolism 4.6/100 patient-years, bleeding 3.3/100 patient-years, endocarditis 0.96/100 patient-years.
- Inadequate patient recall and knowledge of anticoagulant control (24% knew prothrombin ratio) were noted.
Conclusions:
- Potentially preventable long-term complications are comparable to other series.
- Enhanced patient education and involvement in anticoagulant monitoring can reduce complications.
- Broader indications for antibiotic prophylaxis for dental procedures are suggested.
Objective:
to audit anticoagulant control and endocarditis prophylaxis following heart valve surgery.
Design:
retrospective review of all 190 patients living in Canterbury who had heart valve surgery between January 1981 and December 1986 to determine the incidence of endocarditis and complications of anticoagulation.
Results:
there were 35 late deaths, of which nine were attributed to thromboembolism (3), major bleeding (2), or endocarditis (4). The rate of thromboembolic events, and major bleeding was 4.6 and 3.3/100 patient years of warfarin therapy respectively, while the incidence of late endocarditis was 0.96/100 patient years. Two episodes of endocarditis occurred after minor dental procedures performed without antibiotic prophylaxis. Many dentists indicated that they would not have recommended prophylactic therapy for these procedures. Some patients had inadequate recall of important details of anticoagulant control or endocarditis prophylaxis. Only 24% knew their latest prothrombin ratio, yet a survey of general practitioners revealed that, in their view, the majority of patients may be capable of monitoring their own anticoagulant therapy.
Conclusion:
the incidence of potentially preventable long term complications of heart valve surgery is comparable to other series. Nevertheless, these complications could be reduced by better patient education possibly enhanced by greater involvement of the patient in their anticoagulant control. The indications for antibiotic prophylaxis for dental procedures should be broadened for this group of patients.