Document Type : Research articles

Authors

1 1. Department of Surgical Nursing, Dokuz Eylul University Nursing Faculty, ?zmir, Turkey 2. Ph.D. Candidate, Research Assistant, Department of Surgical Nursing, Graduate School of Health Sciences, Dokuz Eylul University, ?zmir, Turkey

2 Associate Professor, Department of Surgical Nursing, Nursing Faculty, Dokuz Eylul University, ?zmir, Turkey

Abstract

Background: Patients with mechanical heart valve replacement surgery (MHVRS) should be followed up in terms of prosthetic valve-related and open heart surgery complications.    
Objectives: This study aimed to determine the anticoagulant complications in long term in patients with MHVRS.
Methods: This retrospective and descriptive study was conducted in a university hospital, Izmir, Turkey. The data were collected from July to December 2019. In total, 73 patients referring for regular check-ups to the hospital with intervals not exceeded more than 90 days, and those who had international normalized ratio (INR) measurements for January-April-July-October 2018 were included in this study.
Results: The mean age of the patients was obtained at 58.98±12.89 years, and 53.4% (n=39) of the cases were male. Moreover, the mean follow-up period was estimated at 65.98±28.47 months. According to the results, complications developed in 60 patients (82.2%). The first hospitalized unit was the emergency department. The factors affecting the development of complications after MHVRS were evaluated, and a difference was found regarding gender (X2=6.18, P=0.013), comorbidities (X2=25.58, P=0.018), and monthly referral for regular check-ups to the hospital  (X2=5.20, P=0.023). There was no relationship between the INR levels and the development of complications. Furthermore, the results of evaluating the factors affecting the number of hospitalizations after MHVRS revealed that monthly referral to hospital for check-ups (t=3.18, P=0.002) and history of previous valve surgery (Z=201.00, P=0.03) affected the number of hospitalizations.
Conclusion: It was observed that patients frequently refer to the emergency department and struggled with various complications. Moreover, it was found that the patients had frequent bleeding and refer to the emergency service repeatedly. Accordingly, there is a need for interventional studies to reduce postoperative complications and provide the therapeutic INR level.

Keywords

  1. Nishimura RA, Otto CM, Bonow RO, Carabello, BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;70(2):252-89. doi: 10.1016/j.jacc.2017.03.011. [PubMed: 28315732].
  2. Howitt SH, Herring M, Malagon I, McCollum CN, Grant SW. Incidence and outcomes of sepsis after cardiac surgery as defined by the Sepsis-3 guidelines. Br J Anaesth. 2018;120(3):509-16. doi: 10.1016/j.bja.2017.10.018. [PubMed: 29452807].
  3. Karamnov S, Brovman EY, Greco KJ, Urman RD. Risk factors and outcomes associated with sepsis after coronary artery bypass and open heart valve surgeries. Semin Cardiothorac Vasc Anesth. 2018;22(4):359-68. doi: 10.1177/1089253218785362. [PubMed: 29992859].
  4. Bouhout I, Stevens LM, Mazine A, Poirier N, Cartier R, Demers P, et al. Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg. 2014;148(4):1341-6.e1. doi: 10.1016/j.jtcvs.2013.10.064. [PubMed: 24332113].
  5. Havers-Borgersen E, Butt JH, Vinding NE, Torp-Pedersen C, Gislason G, Køber L, et al. Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis. J Thorac Cardiovasc Surg. 2019;159(1):74-83. doi: 10.1016/j.jtcvs.2019.02.061. [PubMed: 30961980].
  6. Lee H, Sung K, Kim WS, Jeong DS, Ahn JH, Carriere KC, et al. Late clinical outcomes after mechanical aortic valve replacement for aortic stenosis: old versus new prostheses. J Thorac Dis. 2018;10(6):3361-71. doi: 10.21037/jtd.2018.06.03. [PubMed: 30069331].
  7. Labaf A, Grzymala-Lubanski B, Stagmo M, Lövdahl S, Wieloch M, Själander A, et al. Thromboembolism, major bleeding and mortality in patients with mechanical heart valves-a population-based cohort study. Thromb Res. 2014;134(2):354-9. doi: 10.1016/j.thromres.2014.06.007. [PubMed: 24985036].
  8. Labaf A, Själander A, Stagmo M, Svensson PJ. INR variability and outcomes in patients with mechanical heart valve prosthesis. Thromb Res. 2015;136(6):1211-5. doi: 10.1016/j.thromres.2015.10.044. [PubMed: 26558830].
  9. Demir Korkmaz FA, Okgün Alcan AL, Karacabay K. Do patients with mechanical heart valves have the appropriate knowledge regarding warfarin therapy and can they adhere to the correct dosage? Turk Gogus Kalp Damar. 2015;23(1):58-65. doi: 10.5606/tgkdc.dergisi.2015.10390.
  10. Demirel E, Uzun Ş. Determination of factors affecting effective INR (International Normalization Ratio) value in ındividuals using warfarin. Turk J Cardiovasc Nurs. 2018;9(19):58-68. doi: 10.5543/khd.2018.86580.
  11. Kılıç S, Çelik A, Çakmak HA, Afşin A, Tekkeşin Aİ, Açıksarı G, et al. The time in therapeutic range and bleeding complications of warfarin in different geographic regions of Turkey: a subgroup analysis of WARFARIN-TR Study. Balkan Med J. 2017;34(4):349-55. doi: 10.4274/balkanmedj.2016.1617. [PubMed: 28443575].
  12. Celik A, İzci S, Kobat MA, Ateş AH, Çakmak A, Çakıllı, Y, et al. The awareness , efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR. Anatol J Cardiol. 2016;16(8):595-600. doi: 10.5152/AnatolJCardiol.2015.6474. [PubMed: 27004711].
  13. Kilic S, Saracoglu E, Qekici Y, Kilic DD, Yildirim A, Kuzu Z. Effects of regular follow-up on quality of life and warfarin efficiency in rural patients. Eur J Ther. 2019;25(3):183-9. doi: 10.5152/EurJTher.2018.602.
  14. Temrel TA, Şahin S, Şan ŞA. What is the success rate of patients using warfarin in maintaining their target ınternational normalized ratio levels? Ankara Med J. 2019;19(2):366-74. doi: 10.17098/amj.577304.
  15. Koçak S, Ertekin B, Öztürk EE, Dündar ZD, Acar T, Girişgin AS. Bleeding due to warfarin treatment: five years of experience. Turk Klinikleri Cardiovasc Sci. 2019;31(3):125-34. doi: 10.5336/cardiosci.2019-65895.
  16. Beyan E, Beyan C, Vaizoğlu SA. Predisposing preventable factors in patients with bleeding due to warfarin usage: evaluation of 114 patients. Clin Appl Thromb Hemost. 2010;16(6):684-7. doi: 10.1177/1076029609338049. [PubMed: 19520686].
  17. Bal U, Aydinalp A, Yilmaz K, Ozcalik E, Hasirci S, Atar I. The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement. J Cardiothorac Surg. 2014;9(1):79. doi: 10.1186/1749-8090-9-79. [PubMed: 24885719].
  18. Valeur N, Mérie C, Hansen ML, Torp-Pedersen C, Gislason GH, Kober L. Risk of death and stroke associated with anticoagulation therapy after mitral valve repair. Heart. 2016;102(9):687-93. doi: 10.1136/heartjnl-2015-308272. [PubMed: 26729693].
  19. Lemaignen A, Birgand G, Ghodhbane W, Alkhoder S, Lolom I, Belorgey S et al. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Clin Microbiol Infect. 2015;21(7):674-e11-8. doi: 10.1016/j.cmi.2015.03.025. [PubMed: 25882356].
  20. Kotnis-Gąska A, Mazur P, Olechowska-Jarząb A, Stanisz A, Bulanda M, Undas A. Sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016–2017. Kardiochir Torakochirurgia Pol. 2018;15(2):79-85. doi: 10.5114/kitp.2018.76472. [PubMed: 30069187].
  21. Saksena D, Muralidharan S, Mishra YK, Kanhere V, Mohanty BB, Srivastava CP, et al. Anticoagulation management in patients with valve replacement. J Assoc Physicians India. 2018;66(1):59-74. [PubMed: 30341847].
  22. Lawley CM, Lain SJ, Algert CS, Ford JB, Figtree GA, Roberts CL. Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta‐analysis. BJOG. 2015;122(11):1446-55. doi: 10.1111/1471-0528.13491. [PubMed: 26119028].
  23. Demir N, Yıldırım Yücelen S, Güven Çetin E, Erol Kalkan K, Öztürkmen YA, Demir E, et al. Determination of INR awareness and achievement rates in patients using warfarin. Sisli Etfal Hostan Tip Bul. 2019;54(3):357-63. doi: 10.14744/SEMB.2019.76993. [PubMed: 33312036].
  24. Sengul S. Determining the gastronomic tourism destinations of turkey: a case of domestic tourists. Balıkesir Univ J Soc Sci Instit. 2017;20(37):375-96.
  25. Sarıkamıs G. Health source of our table: wınter vegetables. Turk Seed Growers Assoc. 2016;5(20):51-7.
  26. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):160S-98S. doi: 10.1378/chest.08-0670. [PubMed: 18574265].
  27. Akins CW, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE. Aortic valve replacement in patients with previous cardiac surgery. J Card Surg. 2004;19(4):308-12. doi: 10.1111/j.0886-0440.2004.4055_11.x. [PubMed: 15245459].
  28. Crawford TC, Magruder JT, Grimm JC, Suarez-Pierre A, Sciortino CM, Mandal K, et al. Complications after cardiac operations: all are not created equal. Ann Thorac Surg. 2017;103(1):32-40. doi: 10.1016/j.athoracsur.2016.10.022. [PubMed: 27884410].