Ogendo S W
Department of Surgery, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi.
East Afr Med J. 2000 Jul;77(7):354-8. doi: 10.4314/eamj.v77i7.46667.
To determine the pattern of anticoagulation control for post heart-valve surgery for patients on follow up at Kenyatta National Hospital (KNH).
A combined prospective and restrospective hospital-based study. Retrospective period from January 1991 to 31st August 1997, while the prospective period was from 1st September 1997 to 31st November 1999.
Cardiothoracic surgery clinic, Kenyatta National Hospital, Nairobi.
Post heart valve surgery patients on warfarin and attending the cardiothoracic surgery clinic at Kenyatta National Hospital.
Clinic attendance intervals, average warfarin dosages, interval of dosage change, INR values and variations from accepted normal.
A total of 103 patients fulfilled the criteria for inclusion into the study consisting of 77 mitral valve replacements, 18 aortic valve replacements, seven double valve replacements and one mitral valve repair. The total follow up time for the study period is 316.9 patients years. On average, patients attended their anticoagulation clinic once every 59 days. The average dose of warfarin prescribed was 6.81 mg daily (+/-2.67 mg), with double valve replacement patients receiving a statistically significant lower dosage of 6.04 mg (+/-1.36 mg), (95% confidence limits). On average, a warfarin dose change was made 1.48 times a year per patient. 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 significantly lower level of INR (95% confidence limits). Only during 18% of the follow up time was adequate anticoagulation maintained. During the study period only 6.9% of patients were able to maintain adequate anticoagulation for 50% or more of their follow up time.
Anticoagulation control at the KNH still needs some improvements in clinic attendance and better dosage adjustments to achieve more appropriate INR values.
确定肯雅塔国家医院（KNH）接受心脏瓣膜置换手术患者随访期间的抗凝控制模式。
一项前瞻性与回顾性相结合的基于医院的研究。回顾期为1991年1月至1997年8月31日，前瞻性期为1997年9月1日至1999年11月31日。
内罗毕肯雅塔国家医院心胸外科诊所。
在肯雅塔国家医院心胸外科诊所就诊的接受华法林治疗的心脏瓣膜置换术后患者。
门诊就诊间隔、华法林平均剂量、剂量变化间隔、国际标准化比值（INR）值以及与公认正常值的差异。
共有103例患者符合纳入本研究的标准，其中77例行二尖瓣置换术，18例行主动脉瓣置换术，7例行双瓣膜置换术，1例行二尖瓣修复术。研究期间的总随访时间为316.9患者年。平均而言，患者每59天到抗凝门诊就诊一次。华法林的平均处方剂量为每日6.81毫克（±2.67毫克），双瓣膜置换患者的剂量在统计学上显著较低，为6.04毫克（±1.36毫克）（95%置信区间）。平均而言，每位患者每年调整华法林剂量1.48次。所有患者的平均INR为2.50（±1.18）。二尖瓣置换、主动脉瓣置换、双瓣膜置换和二尖瓣修复患者的相应值分别为2.53（±1.21）、2.32（±1.04）、2.5（±1.05）和2.02（±0.53）。二尖瓣修复患者的INR水平显著较低（95%置信区间）。仅在18%的随访时间内维持了充分的抗凝。在研究期间，只有6.9%的患者能够在其随访时间的50%或更多时间内维持充分的抗凝。
肯雅塔国家医院的抗凝控制在门诊就诊和更好的剂量调整方面仍需改进，以实现更合适的INR值。
