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• W2405994733 abstract "PATTERN OF ANTICOAGULATION CONTROL AFTER HEART VALVE SURGERY AT THEKENYATTA NATIONAL HOSPITAL, NAIROBIS.W.O. OGENDOABSTRACTObjective : To determine the pattern of anticoagulation control for post heart-valve surgeryfor patients on follow up at Kenyatta National Hospital(KNH).Design : A combined prospective and restrospective hospital-based study. Retrospectiveperiod from January 1991 to 31st August 1997, while the prospective period was from 1stSeptember 1997 to 31st November 1999.Setting: Cardiothoracic surgery clinic, Kenyatta National Hospital, Nairobi.Patients: Post heart valve surgery patients on warfarin and attending the cardiothoracicsurgery clinic at Kenyatta National Hospital.Main outcome measures: Clinic attendance intervals, average warfarin dosages, interval ofdosage change, INR values and variations from accepted normal.Results: A total of 103 patients fulfilled the criteria for inclusion into the study consisting of77 mitral valve replacements, 18 aortic valve replacements, seven double valve replacementsand one mitral valve repair. The total follow up time for the study period is 316.9 patientsyears. On average, patients attended their anticoagulation clinic once every 59 days. Theaverage dose of warfarin prescribed was 6.81mg daily(±2.67mg), with double valvereplacement patients receiving a statistically significant lower dosage of 6.04 mg (±1.36mg),(95% confidence limits). On average, a warfarin dose change was made 1.48 times a year perpatient. For all the patients, the mean INR was 2.50 (±1.18). The respective values for mitral,aortic, double valve replacement and the mitral repairs were 2.53(±1.21), 2.32 (±1.04), 2.5(±1.05) and 2.02 (±0.53), respectively. Mitral valve repair patients maintained a significantlylower level of INR (95% confidence limits). Only during 18% of the follow up time wasadequate anticoagulation maintained. During the study period only 6.9% of patients wereable to maintain adequate anticoagulation for 50% or more of their follow up time.Conclusion: Anticoagulation control at the KNH still needs some improvements in clinicattendance and better dosage adjustments to achieve more appropriate INR values.INTRODUCTIONAnticoagulation forms an essential part of the followup of all patients with prosthetic heart valves with or withoutatrial fibrillation. The use of anticoagulation in this group ofpatients is now well established and essential to reducemorbidity associated with this state(1,2). The relative riskvaries with the different models of valves, (all of which havedifferent haemodynamic characteristics), patients age, leftatrial size, the presence of congestive cardiac failure andatrial fibrillation amongst other things(3).In order to prevent thrombo-embolic phenomenaanticoagulants are prescribed, of which warfarin is themost common. Appropriate levels of anticoagulation usingwarfarin are now universally monitored by the internationalnormalised ration (INR).The WHO introduced INR as a mode of standardisinganticoagulation in the early 1980s(4) and this wassubsequently adopted at the Kenyatta National Hospital(KNH), Nairobi in 1987. This standardisation becamenecessary due to the widely differing anticoagulationprotocols and thromboplastins in place worldwide priorthe time. The year 1991 was the first full year from whenINR was used on a routine basis at the KNH.The ideal level of anticoagulation in post-operativevalve patients has been subject of a lot of debate over the yearsand was previously based on observational studies rather thanscientific testing(5,6). More recently the concept of valvespecific anticoagulation is emerging as it has been realisedthat the thrombogenicity of different valves varies widely.The newer (or second generation) range of valves are generallyless thrombogenic than their first generation counterparts.Key to the efficient control anticoagulation is theformation of a reliable follow up service of the patients.Regular attendance by the patients, supplemented by asystem of quality control anticaogulation are theprerequisites of such a service. In some centres where suchquality control systems are in place, levels of adequateINR control maintained up to 80% of the patients attendingthe anticoagulation clinic for up to 60% or more theirfollow up time(8).This study looks at the pattern of anticoagulation" @default.
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• W2405994733 date "2000-01-01" @default.
• W2405994733 modified "2023-09-26" @default.
• W2405994733 title "PATTERN OF ANTICOAGULATION CONTROL AFTER HEART VALVE SURGERY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI" @default.
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