Evaluation of How to Use Warfarin after Heart Valves Replacement Operations

Abstract

Introduction Implantation of prosthetic valve requires a life time consumption of anticoagulation. Thrombotic and embolism complications as well as bleeding associated with anticoagulants are the leading cause of mortality and morbidity after heart valve surgery. Accordingly, this study is designed to explore and report the complications and factors related to usage of warfarin and constant check of prothrombin time and international normalized ratio. Method: This is an observational study in which the medical records of 100 patients with an average age of 47.9 ± 13.4 years undergoing surgery for replacement of heart valves were studied. All factors related to mortality and postoperative complications were extracted, and the patients were followed up for one year. Results: The results suggested that tricuspid valve insufficiency was significantly correlated other valvular defects. Nine patients died; one patient in the operating room, one patient in the ICU, one patient in the ward and six patients during the first year died after the surgery. Two of the patients needed redo-surgery in the first year. It should be noted that among patients receiving warfarin on a regular basis (n=81), no mortality was reported in a one-year fallow-up. Conclusion: In this study, out- of-hospital mortality only occurred in patients' irregular usage of warfarin and without follow-up coagulation tests. So, we conclude that in developing country, if we cannot follow and train the patients constantly for warfarin usage and blood tests, mechanical valve utilization would be concomitant with high risk complications.