微信平台管理对心脏机械瓣膜置换术后抗凝治疗的随机对照研究

目的 通过前瞻性、随机、单中心研究比较微信平台管理与常规术后管理对于心脏机械瓣膜置换术后应用华法林抗凝治疗的疗效和并发症.方法 根据入选标准将宁波市医疗中心李惠利医院心脏机械瓣膜置换术后患者按出院时间排序,奇数组设为观察组(微信平台管理组,153例),偶数组设为对照组(常规术后管理组,144例).对照组进行常规术后护理...

A randomised controlled trial of warfarin anticoagulation after mechanical heart valve replacement via WeChat platform management

  Objective   A prospective, randomised, single-centre study was conducted to compare the efficacy and complications of warfarin anticoagulation in patients undergoing mechanical heart valve replacement postoperative management of patients was performed via WeChat platform or conventional methods.   Methods   According to the inclusion criteria, the patients in our hospital after undergoing mechanical valve replacement were randomly assigned to an experimental group (WeChat platform management group) and a control group (traditional management group). The control group received routine postoperative nursing guidance, whereas the experimental group received continuous nursing intervention via WeChat platform. Through regular outpatient follow-up, warfarin dosage was adjusted, and the general situation and complications of the two groups were recorded. The primary end point was international normalised ratio (INR) compliance rate, whereas the secondary end point included death, thromboembolism, bleeding and the number of, and anticoagulation-related emergency department visits.   Results   A total of 297 patients were enrolled in this study. No significant difference was observed between the two groups in terms of baseline characteristics, including gender, age and type of surgery. Compared with the control group, the experimental group had significantly improved INR compliance rate (75.48% vs. 59.38%, respectively; P < 0.001). No significant difference was found between the two groups in terms of major bleeding events (1.31% vs. 2.78%, respectively; P=0.368), thromboembolism events (1.31% vs. 0.69%, respectively; P=0.598) and deaths from any cause (0.65% vs. 1.39%, respectively; P=0.527). However, the incidence of mild bleeding events (17.6% vs. 30.6%, respectively; P=0.023) and the number of anticoagulation-related emergency department visits [0.86(0.00, 1.00) vs. 1.36(1.00, 2.00), respectively; P=0.031] in the experimental group were lower than those in the control group.   Conclusion   Compared with routine postoperative management, the application of WeChat platform to manage anticoagulation treatment of the patients after mechanical heart valve replacement can improve the INR compliance rate, reduced the incidence of mild bleeding events and the number of, anticoagulation-related emergency department visits.