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

Area of Science:

• Cardiology
• Pharmacology
• Medical Devices

Background:

• Warfarin management is crucial for mechanical heart valve recipients.
• Self-testing for international normalized ratio (INR) improves warfarin management and reduces adverse events.
• Current practice initiates INR self-testing weeks after hospital discharge.

Purpose of the Study:

• To compare in-hospital initiation of INR self-testing versus usual care.
• To evaluate the impact on INR management and adverse events in mechanical heart valve recipients.

Main Methods:

• 200 adult mechanical heart valve recipients were randomized to in-hospital INR self-testing instruction or usual care.
• Self-testing instruction began on the fourth postoperative day.
• Patients were followed for 3 months to assess INR tests, time in therapeutic range, and adverse events.

Main Results:

• The self-testing group performed more INR tests (14 vs. 10).
• A higher percentage of INR tests were within the therapeutic range in the self-testing group (52% vs. 45%, P = .05).
• Adverse events, including transient ischemic attack and bleeding, were similar between groups.

Conclusions:

• In-hospital initiation of INR self-testing improves anticoagulation management in the early postoperative phase.
• While adverse event rates were similar, improved INR control with self-testing is expected to benefit larger patient populations.
• Early self-testing instruction is beneficial for mechanical heart valve recipients on warfarin.