Blutgerinnungsmanagement nach mechanischem Herzklappenersatz

Patient Self-Management of oral Anticoagulation after mechanical
heart valve replacement – Long term experience of the Department of
Heart Surgery Ludwig-Maximilians-University Munich. Objectives:
Lifelong oral anticoagulation treatment (OAT) is necessary after
mechanical heart valve replacement. This study was conducted to
find out differences in bleeding and thromboembolic complications
between Patient Self-Management (PSM) of OAT with portable
coagulometers and Conventional Patient Management (CPM) by the home
physician. We also wanted to find out in which group more
anticoagulation-values were within the therapeutic range and in
which group quality of life is better. Methods: 444 Patients were
included in this retrospective study (PSM-group n=160, CPM-group
n=260, 24 patients were lost to follow up). Follow-up time was 95,0
(+/-23,5) months in PSM-group and 104,9 (+/- 28,5) months in
CPM-group. Patients underwent mechanical heart valve replacement in
our centre between 1982 and 1998. PSM-education began 1992.
Follow-up time was 95,0 (+/-23,5) months in PSM-group and 104,9
(+/- 28,5) months in CPM-group. In PSM-group age was 61,2 (+/-
10,2) years, in CPM-group 66,4 (+/- 8,1) years at follow-up.
Patients in PSM-group were trained using portable coagulometers and
dose adjusting their coumarin-derivate (mostly Marcumar). Results:
Patients in PSM-group measured their coagulation values 3,74
(+/-3,41) times per month, in CPM-group 1,53 (+/- 1,07) times per
month. In the PSM-group, 73% of coagulation values measured were
within the therapeutic range. In the CPM-group 57% of the values
were within the therapeutic range. Grade 2 or 3 bleeding
complications were 2,2% per patient year in PSM-group and 2,7% in
CPM-group. Grade 2 or 3 thromboembolic complications were 0,58% per
patient year in PSM-group and 1,7% in CPM-group. Quality-of-life
aspects were significantly better in PSM-group than in CPM-group.
Conclusions: PSM improves long-time OAT after mechanical heart
valve replacement. More anticoagulation values were within the
therapeutic range and fewer thromboembolic complications appeared
in PSM-group. Quality of life was better in PSM-group. For that
reason we offer and recommend PSM to all suitable patients after
mechanical heart valve replacement.