Anticoagulation management in patients with mechanical heart valve replacement: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Meiqin ¹ , QIU Hanfan ² , XIE Xianbiao ² , CHEN Meilian ² ,  SONG Hongtao ¹

1. Department of Pharmacy, Fuzhou General Hospital, Fuzhou,350025, P.R.China;
2. Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, 350025, P.R.China;

Corresponding author：

SONG Hongtao, Email: sohoto@vip.163.com

Keywords：

Warfarin; mechanical heart valve replacement surgery; anticoagulation management; clinical pharmacist

DOI：

10.7507/1007-4848.201603072

Video：

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Objective To investigate the role of clinical pharmacists in warfarin therapy. Methods A total of 134 patients underwent prosthetic heart valve replacement and had warfarin for life from March 2013 to October 2013 in Fujian Medical University Union Hospital. All patients were equally divided into two groups (an intervention and a non-intervention group) crosswise by sequence. There were 67 patients in each group. The anticoagulant effects of the two groups were compared. Results There was no statistical difference in the patients' demographic information between the two groups. However, the time for the patients to reach the target international normalized ratio(INR) values for the first time (7.1±3.3 dvs. 10.5±5.0 d,P=0.000) and time of INR in the therapy range (46.3%±18.8%vs.19.0%±16.2%,P=0.000) during their hospitalization, proportion of time of under anticoagulation (47.5%±19.5%vs. 71.2%±22.9%,P=0.000), proportion of time of anticoagulation overdose (5.3%±8.2%vs. 9.9%±16.7%,P=0.002) were significantly different. While there was no statistical difference in postoperative hospitalization time between the two groups (19.9±6.6 dvs. 18.1±7.0 d,P=0.137). There were 4 patients (6.0%) with minor hemorrhage and no severe complication was found in the intervention group. There were seven patients (10.4%) with mild hemorrhage, two patients with stroke, one patient with mild pulmonary embolism, and severe complication rate of 4.5% in the non-intervention group. Conclusion With clinical pharmacists involved in the whole anticoagulation therapy progress of patients after mechanical heart valve replacement, the time to achieve the therapeutic window for the first time is effectively shorten, and the time of the INR value controlled in therapeutic range is highly improved during hospitalization time. Moreover, the patients' risk of thrombosis and bleeding is eventually reduced.

Citation： LIN Meiqin, QIU Hanfan, XIE Xianbiao, CHEN Meilian, SONG Hongtao. Anticoagulation management in patients with mechanical heart valve replacement: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 285-289. doi: 10.7507/1007-4848.201603072 Copy

1.	黄雪珊, 陈道中, 廖崇先, 等. 人工机械瓣膜置换术 50 例抗凝治疗随访. 福建医科大学学报, 2003, 37(2): 224-226.
2.	张小飞, 肖亦敏, 程云阁, 等. 心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析. 中国胸心血管外科临床杂志, 2014, 21(2): 270-271.
3.	朱志成, 李丹, 王天策, 等. 东北人群人工机械瓣膜置换术后低强度抗凝治疗的单中心研究. 中国胸心血管外科临床杂志, 2014, 21(2): 160-163.
4.	The International Warfarin Pharmacogenetics Consortium. Estimation of the warfarin dose with clinical and pharmacogenetic data. N Engl J Med, 2009, 360(8): 753-764.
5.	Kimmel SE, French B, Kasner SE, et al. A pharmacogenetic versus a clinical algorithm for warfarin dosing. N Engl J Med, 2013, 369(24): 2283-2293.
6.	Pirmohamed M, Burnside G, Eriksson N, et al. A randomized trial of genotype-guided dosing of warfarin. N Engl J Med, 2013, 369(24): 2294-2303.
7.	Furie B. Do pharmacogenetics have a role in the dosing of vitamin K antagonists? N Engl J Med, 2013, 369(24): 2345-2346.
8.	Elewal H, Jalali F, Khudair N, et al. Evaluation of pharmacist-based compared to doctor-based anticoagulation management in Qatar. J Eval Clin Pract, 2016, 22(3): 433-438.
9.	Entezari-Maleki T, Dousti S, Hamishehkar H, et al. A systematic review on comparing 2 common models for management of warfarin therapy: pharmacist-led service versus usual medical care. J Clin Pharmacol, 2016, 56(1): 24-38.
10.	Bishop L, Young S, Twells L, et al. Patients’ and physicians’ satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic. BMC Res Notes, 2015, 8: 233.
11.	Young S, Bishop L, Twells L, et al. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic. BMC Family Practice, 2011, 12: 88.
12.	Hicho MD, Rybarczyk A, Boros M. Interventions unrelated to anticoagulation in a pharmacist-managed anticoagulation clinic. Am J Health-Syst Pharm, 2016, 73(3): S80-S87.
13.	中华医学会心血管病学分会、中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 2013, 52(1): 76-82.
14.	Lane MA, Zeringue A, McDonald JR. Serious bleeding events due to warfarin and antibiotic co-prescription in a cohort of veterans. Am J Med, 2014, 127(7): 657-663.
15.	Arnold LM, Nissen LR, Ng TM. Moxifloxacin and warfarin: additional evidence for a clinically relevant interaction. Pharmacotherapy, 2005, 25(6): 904-907.
16.	Yamamoto H, Habu Y, Yano I, et al. Comparison of the effects of azole antifungal agents on the anticoagulant activity of warfarin. Biol Pharm Bull, 2014, 37(12): 1990-1993.
17.	Danie LM, Barreto JN, Kuth JC, et al. Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy. Am J Health-Syst Pharm, 2015, 72(14): 1195-1203.
18.	McEwen BJ. The influence of herbal medicine on platelet function and coagulation: a narrative review. Semin Thromb Hemost, 2015, 41(3): 300-314.
19.	Tsai HH, Lin HW, Lu YH, et al. A review of potential harmful interactions between anticoagulant/antiplatelet agents and chinese herbal medicines. Plos One, 2013, 8(5): e64255.
20.	Chua YT, Ang XL, Zhong XM, et al. Interaction between warfarin and Chinese herbal medicines. Singapore Med J, 2015, 56(1): 11-18.

1. 黄雪珊, 陈道中, 廖崇先, 等. 人工机械瓣膜置换术 50 例抗凝治疗随访. 福建医科大学学报, 2003, 37(2): 224-226.
2. 张小飞, 肖亦敏, 程云阁, 等. 心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析. 中国胸心血管外科临床杂志, 2014, 21(2): 270-271.
3. 朱志成, 李丹, 王天策, 等. 东北人群人工机械瓣膜置换术后低强度抗凝治疗的单中心研究. 中国胸心血管外科临床杂志, 2014, 21(2): 160-163.
4. The International Warfarin Pharmacogenetics Consortium. Estimation of the warfarin dose with clinical and pharmacogenetic data. N Engl J Med, 2009, 360(8): 753-764.
5. Kimmel SE, French B, Kasner SE, et al. A pharmacogenetic versus a clinical algorithm for warfarin dosing. N Engl J Med, 2013, 369(24): 2283-2293.
6. Pirmohamed M, Burnside G, Eriksson N, et al. A randomized trial of genotype-guided dosing of warfarin. N Engl J Med, 2013, 369(24): 2294-2303.
7. Furie B. Do pharmacogenetics have a role in the dosing of vitamin K antagonists? N Engl J Med, 2013, 369(24): 2345-2346.
8. Elewal H, Jalali F, Khudair N, et al. Evaluation of pharmacist-based compared to doctor-based anticoagulation management in Qatar. J Eval Clin Pract, 2016, 22(3): 433-438.
9. Entezari-Maleki T, Dousti S, Hamishehkar H, et al. A systematic review on comparing 2 common models for management of warfarin therapy: pharmacist-led service versus usual medical care. J Clin Pharmacol, 2016, 56(1): 24-38.
10. Bishop L, Young S, Twells L, et al. Patients’ and physicians’ satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic. BMC Res Notes, 2015, 8: 233.
11. Young S, Bishop L, Twells L, et al. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic. BMC Family Practice, 2011, 12: 88.
12. Hicho MD, Rybarczyk A, Boros M. Interventions unrelated to anticoagulation in a pharmacist-managed anticoagulation clinic. Am J Health-Syst Pharm, 2016, 73(3): S80-S87.
13. 中华医学会心血管病学分会、中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 2013, 52(1): 76-82.
14. Lane MA, Zeringue A, McDonald JR. Serious bleeding events due to warfarin and antibiotic co-prescription in a cohort of veterans. Am J Med, 2014, 127(7): 657-663.
15. Arnold LM, Nissen LR, Ng TM. Moxifloxacin and warfarin: additional evidence for a clinically relevant interaction. Pharmacotherapy, 2005, 25(6): 904-907.
16. Yamamoto H, Habu Y, Yano I, et al. Comparison of the effects of azole antifungal agents on the anticoagulant activity of warfarin. Biol Pharm Bull, 2014, 37(12): 1990-1993.
17. Danie LM, Barreto JN, Kuth JC, et al. Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy. Am J Health-Syst Pharm, 2015, 72(14): 1195-1203.
18. McEwen BJ. The influence of herbal medicine on platelet function and coagulation: a narrative review. Semin Thromb Hemost, 2015, 41(3): 300-314.
19. Tsai HH, Lin HW, Lu YH, et al. A review of potential harmful interactions between anticoagulant/antiplatelet agents and chinese herbal medicines. Plos One, 2013, 8(5): e64255.
20. Chua YT, Ang XL, Zhong XM, et al. Interaction between warfarin and Chinese herbal medicines. Singapore Med J, 2015, 56(1): 11-18.

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