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Maegerlein, Christian (2009): Blutgerinnungsmanagement nach mechanischem Herzklappenersatz: Vergleich des Patienten-Selbstmanagements mit der konventionellen Gerinnungsbestimmung und Gerinnungseinstellung durch den Hausarzt. Dissertation, LMU München: Faculty of Medicine
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Abstract

Patient Self-Management of oral Anticoagulation after mechanical heart valve replacement – Long term experience of the Department of Heart Surgery Ludwig-Maximilians-University Munich. Objectives: Lifelong oral anticoagulation treatment (OAT) is necessary after mechanical heart valve replacement. This study was conducted to find out differences in bleeding and thromboembolic complications between Patient Self-Management (PSM) of OAT with portable coagulometers and Conventional Patient Management (CPM) by the home physician. We also wanted to find out in which group more anticoagulation-values were within the therapeutic range and in which group quality of life is better. Methods: 444 Patients were included in this retrospective study (PSM-group n=160, CPM-group n=260, 24 patients were lost to follow up). Follow-up time was 95,0 (+/-23,5) months in PSM-group and 104,9 (+/- 28,5) months in CPM-group. Patients underwent mechanical heart valve replacement in our centre between 1982 and 1998. PSM-education began 1992. Follow-up time was 95,0 (+/-23,5) months in PSM-group and 104,9 (+/- 28,5) months in CPM-group. In PSM-group age was 61,2 (+/- 10,2) years, in CPM-group 66,4 (+/- 8,1) years at follow-up. Patients in PSM-group were trained using portable coagulometers and dose adjusting their coumarin-derivate (mostly Marcumar). Results: Patients in PSM-group measured their coagulation values 3,74 (+/-3,41) times per month, in CPM-group 1,53 (+/- 1,07) times per month. In the PSM-group, 73% of coagulation values measured were within the therapeutic range. In the CPM-group 57% of the values were within the therapeutic range. Grade 2 or 3 bleeding complications were 2,2% per patient year in PSM-group and 2,7% in CPM-group. Grade 2 or 3 thromboembolic complications were 0,58% per patient year in PSM-group and 1,7% in CPM-group. Quality-of-life aspects were significantly better in PSM-group than in CPM-group. Conclusions: PSM improves long-time OAT after mechanical heart valve replacement. More anticoagulation values were within the therapeutic range and fewer thromboembolic complications appeared in PSM-group. Quality of life was better in PSM-group. For that reason we offer and recommend PSM to all suitable patients after mechanical heart valve replacement.