华法林心脏瓣膜术后抗凝的依从性研究

Analysis of warfarin compliance in patients undergoing mechanical heart valve replacement

目的：探讨心脏瓣膜置换术后口服华法林的依从性及其相关因素。方法行机械瓣膜置换手术38例患者，术后第1天口服华法林，首剂量4.5 mg，根据NIR水平调整华法林剂量，出院后继续维持剂量，并定期检查INR水平。随访调查患者出院后华法林口服依从性及其相关影响因素。结果华法林服药后抗凝效果达到稳定时间为（10.6±4.2）d，稳定后维持用量为每日（2.7±1.1）mg，华法林用量个体差异较大（0.5～8.0 mg）。多因素分析显示，文化程度、收入水平及服药期间是否出血是影响口服华法林依从性的相关因素（均P＜0.05）。结论受教育程度低，服药期间有出血事件的低收入患者口服华法林依从性较差。

Objective To explore the factors related to warfarin compli-ance in patients undergoing mechanical heart valve replacement.Methods A total of 38 patients undergoing mechanical heart valve replacement were included in this study.Warfarin was orally given on the first day with the first dosage of 4.5 mg.And warfarin dosage changed according to the International Normalized Ratio （ INR） index.The outpa-tients were constantly administered with warfarin and were adjusted according to INR value.The warfarin dosage and related factors for compliance were recorded and analyzed.Results The mean time for achieving stable anticoagulant effect after taking the drug was （10.6 ±4.2） days.The sustaining dosage was （2.7 ±1.1） mg a day when achieving stable anticoagulant effect with a range of 0.5 to 8 mg a day.Multiple factors analysis demonstrated that education, income and bleeding were the factors that affected the warfarin compliance （ P〈0.05） .Conclusion The risk factors for bad compliance administration of warfarin were low education, low income and experiences of bleeding.