Patients undergoing heart valve surgery (both mechanical and biologic valves) and prosthetic ring implantation are required to take anticoagulants; patients and families who lack medical knowledge may have many questions they need to know. The following are brief answers to questions you may have. Please note that this article is based on our clinical experience, with reference to a wide range of national and international sources. It is intended to help patients and families gain an initial understanding of the issues related to anticoagulation after heart valve surgery, and is not a treatment protocol or guideline and does not have any legal effect. Despite our experience, due to the complexity of medical issues and the individual differences in each patient, the recommendations provided herein may lead to adverse events during their specific implementation. Therefore, we recommend that when you encounter a specific problem, you should contact your physician in charge at the time of surgery at an early stage or visit a major hospital with cardiac surgery to resolve it under the guidance of a cardiac surgeon. 1.Why do I need to take anticoagulants? Human blood is in contact with endothelial cells when it flows in blood vessels and the heart, and blood does not clot in blood vessels. In contrast, once the blood comes into contact with any foreign body other than the endothelial cells of the blood vessels, the clotting system of the blood will be activated to produce clots, resulting in blockage of the blood vessels. Prosthetic valves and rings are artificial and are foreign bodies to the body and will definitely activate the clotting system to produce clots. When clots are generated, they can lead to impaired prosthetic leaflet movement and can also be washed off the prosthetic valve surface by blood flow causing blockage of downstream vessels (medically known as embolism). After taking anticoagulants can achieve lubrication of the contact surface of blood and artificial materials, thus avoiding the formation of clots, so both the artificial valve and the valve ring implantation need to take anticoagulants. 2.What kind of anticoagulant is taken? The oral anticoagulants currently used in clinical practice are vitamin K antagonists, and commonly used vitamin K antagonists include warfarin (double coumarin) and new anticoagulation (vinblastine coumarin). Warfarin is a synthetic drug and is the best of the coumarins. Warfarin may have other trade names in some places, but you will find the word “warfarin” on its outer box. Warfarin 3mg per tablet, imported from Finland, and warfarin 2 or 5mg per tablet, made in China, are commonly available in the market. 3. How long do I need to take this drug? If you have a mechanical valve, you have to take it for the rest of your life; if you have a biological valve or an artificial valve ring, you can take it for half a year if your ECG is sinus rate after surgery. If the postoperative is still atrial fibrillation or other conditions, consult your physician, according to the physician’s requirements. 4.What is the dose of one warfarin tablet? Finnish warfarin is 3mg a piece, domestic warfarin is 2 or 5mg a piece, remember to read what is written on the package, when eating do not remember to take a few tablets, but to remember to take a few mg (milligrams). If you switch to a different manufacturer’s drug, the INR value should be frequently rechecked at the beginning of the switch to avoid excessive fluctuations in the INR value. 5.What are the side effects of taking the drug warfarin? The drug itself has few side effects on the body’s organ functions. However, the drug can affect the coagulation function if the drug is not taken in the right amount: if the drug is taken too much, the blood is too thin, which can lead to bleeding in body parts, such as bleeding from brushing teeth, subcutaneous bruising, and even intracranial bleeding. Drugs taken too little, the blood is too viscous, easy to form clots in the artificial valve parts affect the valve switch, clots can lead to blockage of blood vessels, so the correct use of anticoagulants is more important task than eating and drinking water. 6, the so-called “check anticoagulation” “blood test” in the end what test? The index to be checked in each blood test is the “International Normalized Ratio of prothrombin time”, INR is its abbreviation in English. This value is consistent from hospital to hospital and does not change from hospital to hospital, nor is it inaccurate due to changes in the examiner. The size of the amount of medication we take is adjusted based on the size of the INR value. 7.What is the standard of INR value to be achieved? The normal human INR value is 1,0. Patients with mitral valve replacement or mitral valve prosthetic ring implantation should control the INR between 1,8 and 2,5, and around 2,2 is more ideal; patients with aortic valve replacement, the INR should be between 1,8 and 2,2 is more ideal; if the mitral valve and aortic valve are replaced at the same time, the INR should be controlled between 1,8 and 2,5, and around 2,2 is more ideal; tricuspid valve replacement, the INR should be controlled between 1,8 and 2,5, and around 2,2 is more ideal. more ideal; tricuspid valve replacement or artificial valve ring implantation patients INR should be controlled between 2, 5 and 3, 0. 8.How can I see the INR after it is found? How do I take the medication? The first dose varies from unit to unit. We usually start with the first dose of 3 mg, and take the medication until it reaches about 2.0 in 48 to 72 hours, indicating that the dose of medication is appropriate. If it is lower than 1,8, it means that the dose is not enough and it needs to add 1/6 to 1/4 tablet of medication, if it is higher than 2,5, it means that the dose is too big and it needs to reduce 1/6 to 1/4 tablet of medication. After tricuspid valve replacement INR control at about 3, 0, if the test results are low or high, also increase or reduce the anticoagulant drugs accordingly. 9.What should I do if I am always unsatisfied with the control by adding or reducing the dosage? Add or reduce the amount of drugs to 1/6 to 1/4 tablets is appropriate, and if it is still the case, adopt the principle of rather low than too high. Because if you eat less, valve thrombosis may occur; if you eat more, you will bleed, and bleeding is even more dangerous. The patient’s INR check value is usually different each time, as long as the value is controlled between 1,8 and 2,5 is eating just right. 10.Why am I given to stop the medication once in a while when I am hospitalized, and when do I need to stop it? If the INR is too high, such as over 3, it is generally recommended to stop the medicine for 1 day. If it is particularly high, such as over 5, or even 6, 7, 8, especially if there is bleeding from the nose, mouth, teeth, blood in the urine or whatever at the same time, you need to stop the medicine immediately, and then finally go to a nearby hospital as soon as possible to have the cardiologist or cardiac surgeon give the appropriate treatment, such as giving vitamin K. 11.How long does it usually take after increasing and decreasing the dose to cause INR change? The half-life of warfarin is 36 to 42 hours. In other words, the effect can be seen only two days after the increase and decrease of dosage. All, if your INR is particularly high at one time, you can stop it for 2 to 3 days at once, then check it again, and adjust the dosage afterwards according to the situation, and it is generally recommended to start taking a smaller amount of medicine than the original one at this time. During the hospitalization period, that is, early after the surgery, the effect of the medication is not too stable because it has not been long since the medication was first started, that is why the INR is drawn and tested every day and the amount of medication is often adjusted. 12.How often do I need to check the INR after discharge from the hospital? It is usually best to check it once every 2 to 3 days when you are first discharged from the hospital. If the INR value is within the desired range, which is often referred to as more stable, it can become once a week, once every 2 weeks, once a month, but not more than 3 months. If you change the type of anticoagulant or if there is an abnormal situation, such as abnormal bleeding or vascular embolism somewhere, it is recommended to draw blood to check it near you at any time. 13.Where can I check the indicator INR? Hospitals above the county level can usually check it. 14.Is it accurate in general hospitals? As long as the INR value can be checked, the value is the same regardless of the size of the hospital, so there is no need to worry about the error or the level of technology. 15.Do I need to take medicine every day? Unless there is a serious bleeding tendency, the need for surgery, doctor’s orders need to stop the drug, otherwise you should take it every day, preferably at a fixed time every day, such as 8:00 am or 4:00 pm, warfarin is not expensive, about 0,5 yuan per tablet. 16.What has an effect on INR value or on taking medication? A normal diet generally does not have a major effect on anticoagulation. Certain drugs such as antipyretics, cold and flu medications, antibiotics, etc. will increase the effectiveness of warfarin, which requires appropriate dose reduction; vitamin K and multivitamins containing vitamin K will reduce the effect of warfarin, and it is recommended not to take it or take it under the guidance of a doctor. The interval of INR check should be shortened during the combination with other drugs in order to adjust the dose of anticoagulant. 17.What if I want to know more about it? Buy books on anticoagulation knowledge and look up related information online. Anticoagulation is a lifelong thing for you, more important than eating and drinking, all recommended. 18.I can’t understand anything even after reading this, who else can I ask? Please feel free to contact your bedside doctor, who is in charge of your check-up every morning, and after discharge, please consult your local cardiovascular surgery clinic. You are also welcome to visit the cardiovascular surgery clinic at Anzhen Hospital. 19.What if I need another surgery? Since you are previously taking anticoagulants, there is a possibility of hemorrhage during the surgery, so you usually need to stop taking the drugs two days before the surgery; the day after the surgery, start taking the dose of anticoagulants taken before the surgery, and check the INR value frequently in the following days and adjust the dose of drugs according to the results. 20.What is the effect of prosthetic valve replacement on pregnancy and childbirth? The use of anticoagulants has little effect on fertility in male patients. However, in women with prosthetic heart valves, pregnancy and childbirth are a major issue for the safety of mother and child. If pregnancy and childbirth are planned, try to choose a biologic valve at the time of valve replacement, or if a mechanical valve is used, patients must consult with a medical professional prior to pregnancy. 21.Is it necessary to record the INR value of the examination? Taking anticoagulants after valve replacement is more important than eating and drinking, and the amount of medication taken and INR check values are important quantitative indicators. Especially when adjusting the dosage of medication, the doctor often adjusts the INR according to the trend of changes in INR and the amount of medication over a period of time. It is highly recommended that patients record the amount of medication taken and the check value of INR every day (if checked on the same day), and record whether there is bleeding tendency such as gum bleeding, subcutaneous petechiae, hematuria, and any special conditions (such as cold, special food or other medication, etc.).