Guidance on warfarin drug use after heart valve replacement

After patients take warfarin, individual reactions and clinical manifestations of bleeding should be observed, and the dosage should be adjusted in a timely manner to prevent overdose or underdose. Maintenance dosage: generally 3 mg/d. I. Anticoagulant precautions 1. After mechanical flap grafting, lifelong anticoagulation therapy is mandatory. Anticoagulation for 3-6 months after bioprosthetic flap surgery. 2, timely detection: nasal bleeding, gum bleeding, hematuria, abdominal pain, coma and other signs of anticoagulation overdose. 3, timely detection: heart failure, cerebrovascular or extremity vascular embolism symptoms, heart valve audio abnormalities and other signs of anticoagulant insufficiency. (4) Factors affecting blood test results and/or the effectiveness of anticoagulants in the body are as follows: (1) Drugs that weaken the effect of anticoagulants: cholestyramine, rifampin, ashwagandha, estrogen, oral contraceptives, etc. (2) Drugs that enhance the anticoagulant effect, such as broad-spectrum antibiotics and chloramphenicol, metronidazole, alcohol, etc. and drugs that synergistically anticoagulate or interfere with the platelet effect, such as quinidine, antomin, aspirin, pautazone, benadryl, etc. (3) Eat less food with high vitamin K content. (4) Diarrhea, vomiting, right heart failure and liver disease can reduce vitamin K synthesis or absorption. (5) Technical errors in blood tests. If there is a suspected error, the test should be repeated. The performance and management of anticoagulation overload (bleeding) and underload (thrombosis, embolism) is indicated by an internationalization ratio (INR) >3.0 and underload by an INR <1.8. Signs of anticoagulation overload and occurrence of mild, moderate, or severe bleeding. Mild bleeding: bleeding spots on skin, subcutaneous bruising spots after collision, easy bleeding from brushing teeth or gums. Blood tests should be repeated to reduce the amount of anticoagulant appropriately. Moderate bleeding: hematuria or epistaxis. Blood tests should be taken 1-2 days after stopping the drug. Start anticoagulation again when the symptoms disappear and the laboratory results meet the criteria. Severe bleeding: hemoptysis (vomiting), intracranial hemorrhage. If the above symptoms are confirmed to be caused by anticoagulant overdose, vitamin K should be administered intravenously, and after the symptoms disappear, the anticoagulation should be restarted according to the blood test results. During the anticoagulation period, such as tooth extraction, mass removal and other elective or emergency surgeries, it is not necessary to stop the anticoagulant if the bleeding is estimated to be small and can be stopped by compression. Or stop warfarin 3-5 days before surgery, take blood test, and operate after normal. 2, emergency surgery, emergency determination of prothrombin and activity, preoperative sedation of vitamin K, 4 hours later, blood retest, such as close to normal can be operated. It is also possible to operate urgently without waiting for the laboratory results and immediately injecting vitamin K after drawing blood samples. Anticoagulation can be restarted 24-48 hours after surgery if there are no bleeding problems.