1.Which patients with valve disease need anticoagulation? Anticoagulants are recommended for patients with valve disease who have not yet undergone surgery for atrial fibrillation and have a history of embolism; those who have undergone valve replacement surgery with intracardiac implantation of mechanical valves need to be strictly anticoagulated for the rest of their lives; those who have undergone valve replacement surgery with intracardiac implantation of bioprosthetic valves as well as those who have undergone valvuloplasty with intracardiac implantation of valvuloplasty rings need to be strictly anticoagulated for 6 months after surgery; those who have sustained atrial fibrillation after the first 6 months of surgery are recommended to continue the use of Anticoagulants. 2.Why anticoagulation? Because stenosis or atrial fibrillation causes blood flow stagnation or disorders that easily lead to thrombosis, some artificial materials implanted in the heart, such as mechanical valves, as well as implanted within 6 months after the operation rough surface has not yet been covered by the autologous cells of the bioprosthetic valves or valvuloplasty ring, may activate the coagulation mechanism of the formation of blood clots. Cardiac thrombus dislodgement may block important organs or limb blood vessels, cerebral infarction, limb arterial embolism, etc.; valve replacement after intracardiac thrombus formation will affect the activity of the prosthetic valve leaflets, so that the valve opening and closing dysfunction, the serious cardiac valve can lead to sudden death. 3.What kind of anticoagulant is used? Currently, warfarin is the most commonly used anticoagulant; some doctors believe that for atrial fibrillation (AF) in patients with valvular disease who have not undergone surgery, as well as for patients with AF 6 months after bioprosthetic valve replacement, aspirin can be considered as an alternative to warfarin, with the advantage that 100mg orally per day is sufficient, and there is no need for frequent blood tests to detect INR and other indexes. 4. How to evaluate the effect of anticoagulation therapy? The effect of anticoagulation therapy can be detected by some indicators: ProthrombinTime (PT), the normal value of 11.5-14.5 seconds; ProthrombinTimeActivityPercentage (PTA), the normal value of 80-120%; InternationalNormalizedRatio (INR), the normal value of 80-120%. (InternationalNormalizedRatio, referred to as INR), the normal value of 0.8-1.2. The INR is deduced from the PT and the international sensitivity index (ISI) of the reagents, so that the PT measured by different laboratories and different reagents are comparable, and it is recommended to be the unified standard of medication.A low value of INR represents Low INR value means good coagulation function (easy to clot and not easy to bleed), and high INR value means poor coagulation function (not easy to clot and bleed). 5. Within what range should the INR be controlled? The purpose of anticoagulation therapy is to control the blood in a relatively low coagulation state, rather than adjusting it to a normal value. If the INR is within the normal range, the patient mentioned in the answer to question 1 above is at risk of developing an intracardiac thrombus. In other words, the goal of anticoagulation is to keep the patient’s coagulation parameters within a range that deviates from the normal range, where they are relatively less prone to thrombosis and less prone to the dangers of bleeding tendencies associated with excessive anticoagulation. If you have the opportunity to read the American Heart Association Valve Disease Treatment Guidelines (ACC/AHA2006GuidelinesfortheManagementofPatientsWithValvularHeartDisease), you will find that it is recommended that the INR of patients with common valve disease should be controlled at 2.0-3.0, and even recommended to control the INR at 2.0-3.0 in patients with high-risk factors. It is even recommended to control the INR between 2.5-3.5. However, due to differences in race, geography, and dietary structure, Caucasians are significantly more hypercoagulable and Asians are less so, and we have found that the incidence of hemorrhagic events in the Chinese population increases when the INR is close to or exceeds 3.0. So you can’t simply apply these criteria. At Fu Wai Hospital, according to the anticoagulation guideline developed by our Adult Surgery Center in July 2011 in conjunction with clinical practice, we recommend that patients requiring anticoagulation should have their INR adjusted to a range of 1.8-2.5, which we believe is more appropriate for most Chinese patients with valvular disease. In fact, the specific situation of each patient may be different. It is generally believed that patients with atrial fibrillation, bioprosthetic valves, prosthetic rings, and aortic mechanical valves have a relatively low probability of thrombosis, and some physicians believe that the INR of these patients can be loosely controlled in the range of 1.5-2.0; patients with mitral or tricuspid mechanical or prosthetic valves have a relatively high probability of thrombosis, and the INR of these patients may be controlled at a high level, but only in the range of 1.8-2.5. Only 1.8-2.5 is relatively safe. It should be emphasized that these ideal ranges of INR are only suitable for most patients, and no standard can be suitable for everyone. If the INR is controlled within the required range and thrombosis still occurs, the INR needs to be appropriately adjusted closer to the upper limit; on the contrary, if bleeding from the gums or subcutaneous bleeding occurs frequently, the INR should be appropriately adjusted closer to the lower limit. 6.How to adjust the dose of warfarin? The dose of warfarin varies from person to person, generally 4.5mg on the 1st day after surgery, 3mg on the 2nd day, and thereafter the dose is adjusted according to the INR value on that day by: INR<1.8, increase the daily dose by 1/3-1/4; INR>2.5, reduce the daily dose by 1/3-1/4; INR>3.0, or there are obvious signs of gingival or subcutaneous bleeding, etc., it is recommended to stop the dose. Warfarin 1 day timely review INR. During hospitalization, blood will be taken to check INR every day by the doctor to help you adjust the warfarin dosage, it is recommended to check INR every other day or every 2-3 days within 2 weeks after discharge from the hospital, until the INR value and the dosage of warfarin is relatively stable, then the transition to checking 1-2 times a month. Based on the questions frequently asked by patients in clinical work, the above is summarized in the hope that it can help patients understand anticoagulation therapy more fully, and please follow the advice of your treating doctor in making specific treatment decisions.