If we compare the heart to a house, valves are like doors to a room. In the house of the heart, there are four "doors", namely the mitral valve, tricuspid valve, aortic valve, and pulmonary valve. What if the door is broken? Minor problems can be fixed, if not, then replace with a new one. The treatment of heart valve disease follows the same principle.
The new "door" can be divided into two types based on material, namely biological valve and mechanical valve. If the replacement is the mitral valve, we call it mitral valve replacement surgery or mitral valve mechanical valve replacement surgery. The commonly used anticoagulation therapy after switching doors is oral warfarin, which is crucial. If the medication is insufficient, blood clots may grow on the new door, affecting its opening and closing. If the medication is excessive, uncontrollable bleeding may occur in other parts of the body. What should I do after being discharged and returning home when medical staff test corresponding indicators during hospitalization?
Firstly, during hospitalization, it is necessary to clarify with the doctor the appropriate range of home testing indicators and indicators. Currently, the commonly used indicator is the International Normalized Ratio, abbreviated as INR. Generally, early warfarin anticoagulation therapy is given for 3-6 months after mitral valve replacement surgery to achieve an INR value of 1.8-2.5. Afterwards, aspirin 100mg/day can be taken for a long time. After mitral valve replacement surgery, it is recommended to take warfarin anticoagulation for life and maintain an INR value of 1.8-2.5. If there are other factors that require anticoagulation, such as atrial fibrillation, deep vein thrombosis, hypercoagulability, abnormal left ventricular ejection fraction, etc., it is recommended to clarify the control range of INR with the doctor.
When should I go to the hospital for INR value testing during the medication period? Please refer to the table below:
Clinical situation
INR test frequency
INR value reaches target and maintained for at least 2 days
Daily or alternate day test
Within the next 2 weeks
2-3 times a week
INR value continues to stabilize
Once a week
Continuously stable for the next 2 weeks
Once every four weeks
When dose adjustment is needed
Close monitoring of INR value
Even if INR value is relatively stable during warfarin use, it is still recommended that the longest interval between tests should not exceed 1-2 months.
During the use of warfarin, strictly follow the dosage recommended by the doctor or pharmacist, once a day before and after meals, and do not change the drug manufacturer or dosage without authorization. If less than one tablet is taken, it is recommended to use a small knife or tablet cutter to cut the tablets to prevent uneven cutting from affecting the efficacy of the medication.
It is best to take the medication at the same time in the afternoon or evening, without skipping or stopping at will. To avoid missed doses, it is recommended to set an alarm or use a seven day medication box to remind patients to take their medication. If you find that you have indeed missed taking warfarin within 4 hours of taking it, please make up for it as soon as possible at that time; Do not take the supplement after 4 hours, it can be taken normally on the second day. Do not take double the dosage on the second day. If you miss taking medication for 2 consecutive days, you need to restart the medication or consult a doctor immediately.
The efficacy of warfarin is influenced by various factors such as physiological factors, medication, and food. Foods and traditional Chinese medicines that can enhance the anticoagulant effect of warfarin include grapefruit, ginkgo, danshen, goji berry, licorice, angelica, coptis chinensis, and yellow cypress. Foods and traditional Chinese medicines that can weaken the anticoagulant effect of warfarin include spinach, cabbage, lettuce, green leafy vegetables such as cabbage, pork liver, broccoli, ginseng, seaweed, ginger, garlic, green tea, cod liver oil, etc. Therefore, during the medication period, the diet should be balanced and it is advisable not to consume a large amount of a particular substance in a short period of time.
During the use of warfarin, it is necessary to observe for the risk of bleeding and thrombosis. The risk of bleeding mainly depends on whether there are skin petechiae or ecchymoses on the skin; Whether there is nosebleeds, gum and oral bleeding; The color of sputum, urine, and stool; Female patients should pay attention to observing the amount of menstrual flow, and if there are any abnormalities, promptly recheck the INR value and seek medical attention at the hospital. The risk of embolism mainly depends on whether there is dizziness, aphasia, speech difficulties, limb numbness or hemiplegia, unexplained headaches, sudden monocular or binocular visual impairment. If any of the above conditions occur, timely medical attention should be sought, INR values should be monitored, and medication should be taken according to the guidance of a physician.
Patients with neurological symptoms caused by cerebral embolism should be actively hospitalized for treatment.