Telemanagement of anticoagulant therapy for patients after mechanical heart valve replacement: A prospective cohort study
10.7507/1007-4848.201811046
- VernacularTitle:心脏机械瓣膜置换术后抗凝治疗远程管理：前瞻性队列研究
- Author:
LI Jinze
1
;
DONG Yijun
1
;
QIAN Yongjun
1
;
DONG Li
1
Author Information
1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China
- Publication Type:Journal Article
- Keywords:
Heart valve replacement;
anticoagulant therapy;
telemanagement;
time in therapeutic rang;
fraction in therapeutic range
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2019;26(4):343-347
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the safety and efficacy of mobile APP in telemanagement for patients who received oral warfarin anticoagulant therapy after mechanical heart valve replacement. Methods A prospective cohort study was performed. According to the inclusion and exclusion criteria, a total of 80 patients who underwent mechanical heart valve replacement for more than half a year and received oral warfarin anticoagulant therapy in outpatient department were included in our hospital from January 1, 2017 to December 31, 2017. These patients were divided into a telemanagement group (40 paitents, telemanagement using mobile APP) and a control group (40 patients, anticoagulant management in outpatient clinics) according to patients' wishes and local hospital international normalized ratio (INR) monitoring conditions. After 12-month follow-up, clinical effect of the two groups was compared. The INR, time in therapeutic range (TTR), fraction in therapeutic range (FTTR), anticoagulation-related complications and patient satisfaction were analyzed. Results During the follow-up period of anticoagulation, there was no significant difference in INR between the two groups (P=0.732). The average interval of INR monitoring in the telemanagement group was 3-65 (21.4 ± 12.5) days, while that in the control group was 7-93 (39.6 ± 14.7) days (P=0.012). TTR was 42.7% (6 027.6 d/14 116.0 d) in the control group and 67.9% (10 168.6 d/14 972.0 d) in the telemanagement group (P=0.018). And FTTR in the two groups was 45.6% (144/316) and 67.1% (432/644), respectively (P=0.015). No serious thromboembolism or hemorrhage events occurred in the 80 patients during the 12-month follow-up period. There was no significant difference in the incidence of anticoagulation-related complications, general bleeding and embolism between the two groups (P>0.05). Conclusion For patients with stable anticoagulation after cardiac mechanical valve replacement, it is safe and effective to telemanagement by mobile APP. Telemanagement can increase the frequency of anticoagulation monitoring without increasing anticoagulation risk, meanwhile, it also could obtain more convenient and rapid consultation, save time and economic costs,and improve the quality of life and patient satisfaction.
