Follow-Up of Patients with Mechanical Heart Valves During the Pandemic

Abstract

Currently, oral anticoagulant therapy with warfarin appears to be the most effective way to prevent thromboembolic complications in patients with mechanical heart valve. Our aim is to discuss the effects of oral anticoagulant drugs and the importance of vitamin D levels in patients with mechanical heart valve in the light of the relevant literature.

Our study includes 17 patients who were treated with warfarin by measuring INR (International Normalized Ratio) values intermittently between March 2020 and December 2022. It was recommended that patients avoid the use of herbal remedies and food supplements as they may interact with warfarin. It was aimed to maintain the INR value between 2-3 in patients with aortic valve replacement (AVR) and 2.5-3.5 in patients with mitral valve replacement (MVR) and MVR+AVR. In addition to routine laboratory tests, vitamin D levels of the patients were also measured.

There were seven female and 10 male patients in the study. Their ages ranged from 49 to 77, and the mean age was 66.5±7.5 years. The daily dose of warfarin ranged from 2.5 mg to 10 mg, and most patients maintained adequate anticoagulation with 5 mg of warfarin daily. All of our patients had vitamin D deficiency. The mean vitamin D level was 11.45±6.3. There was mild nosebleed in one patient and mild hemoptysis in another patient. They were treated by adjusting the dose of coumadin according to INR values. INR values were more stable with the normalization of vitamin D levels in our patients.

It is important to constantly maintain the INR at target values in order to prevent the development of serious complications such as bleeding and thrombosis in patients with mechanical heart valves. Therefore, it is necessary to regulate the lifestyle of each patient using warfarin by questioning the graph prepared from the INR measurements.