Compliant to Warfarin Therapy after Mechanical Heart Valve Replacement

Ragab S. Shehata, Ahmed A. Elassal, Ayman A. Gabal

Lecturer Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt.
Registrar Cardiothoracic Surgery, King Abdul-Aziz University Hospital, Jeddah, KSA.

DOI: 10.4236/ojts.2014.42009                

Abstract

Introduction: Effective anticoagulation depends on demographic factors, patient education, drug knowledge and compliance. The aim of our study is to determine the factors that influence compliance to warfarin in the mechanical valve patient population and its relationship with thrombo-embolic and bleeding events. Patients and Methods: 113 patients underwent mechanical valve replacement (Aortic, mitral or both) at King Abdul-Aziz University Hospital, from 2006 to 2012, patients divided into two groups according to warfarin compliant. Results: 113 patients reviewed in our study, 69 (61.1%) patients found compliant, 36 (31.9%) patients found non compliant, and 8 (7.1%) patients missed. The mean age for all patients was 39.25 y: 76 (67.3%) ware male, 37 (32.7%) were female. Mean age for compliant patients was 40.19 y versus 33.3 y for noncompliant patients with p value 0.017. Male patient less complaint than female with significant 0.01, the mean frequency of follow up was less (32.32 days) in compliant vs. (67.73 days) in non complaint patient. Conclusion: younger age, female gender, Arabic race, assistance at home, education, and single drug use are factors associated with patient compliant, non compliance are associated with higher mortality and valve related complication.

Keywords

Warfarin, Compliant, Mechanical Valve, Replacement

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kulik, A., et al. (2006) Early Postoperative Anticoagulation after Mechanical Valve Replacement: A Canadian Survey. Journal of Heart Valve Disease, 15, 581.
[2]	Hirsh, J., et al. (2001) Oral Anticoagulants: Mechanism of Action, Clinical Effectiveness, and Optimal Therapeutic Range. CHEST Journal, 119, 8S-21S. http://dx.doi.org/10.1378/chest.119.1_suppl.8S
[3]	Tang, E.O., Lai, C., Lee, K., Wong, R., Cheng, G. and Chan, T. (2003) Relationship between Patients’ Warfarin Knowledge and Anticoagulation Control. Annals of Pharmacotherapy, 37, 34-39.
[4]	Roddie, A.M.S. and Pollock, A. (1988) Therapeutic Control of Anticoagulation: How Important Is Patient Education? Clinical & Laboratory Haematology, 10, 109-112.
[5]	Brigden, M.L., Kay, C., Le, A., Graydin, C. and McLeod, B. (1998) Audit of the Frequency and Clinical Response to Excessive Oral Anticoagulation in an Outpatient Population. American Journal of Hematology, 59, 22-27. http://dx.doi.org/10.1002/(SICI)1096-8652(199809)59:1<22::AID-AJH5>3.0.CO;2-1
[6]	Waterman, A.D., Milligan, P.E., Bayer, L., Banet, G.A., Gatchel, S.K. and Gage, B.F. (2004) Effect of Warfarin Nonadherence on Control of the International Normalized Ratio. American Journal of Health-System Pharmacy, 61, 1258-1264.
[7]	Pamboukian, S.V., Nisar, I., Patel, S., Gu, L., McLeod, M., Costanzo, M.R. and Heroux, A. (2008) Factors Associated with Non-Adherence to Therapy with Warfarin in a Population of Chronic Heart Failure Patients. Clinical Cardiology, 31, 30-34.
[8]	Arnsten, J.H., Gelfand, J.M. and Singer, D.E. (1997) Determinants of Compliance with Anticoagulation: A Case-Control Study. American Journal of Medicine, 103, 11-17. http://dx.doi.org/10.1016/S0002-9343(97)90048-6
[9]	Alec, B., Platt, M.D., Russell Localio, A., Colleen, M., Brensinger, M.S., Dean, G.C., Jason, D.C., Robert Gross, M.D., Catherine, S.P., Maureen Price, R.N., Joshua, P.M., Abigail, C., Craig, W.N., Brian, L.S., Mitchell, S.L. and Stephen, E.K. (2008). Risk Factors for Nonadherence to Warfarin: Results from the IN-RANGE Study. Pharmacoepidemiology and Drug Safety, 17, 853-860.
[10]	Bourguignon, T., Bergoend, E., Mirza, A., Ayegnon, G., Neville, P., Aupart, M.R. and Marchand, M. (2011) Risk Factors for Valve-Related Complications after Mechanical Heart Valve Replacement in 505 Patients with Long-Term Follow-Up. The Journal of Heart Valve Disease, 20, 673-680.