Patient Question: Disease: Two years after mitral valve and aortic valve replacement Content: Last visit to Dr. Song Zhigang or discharge time: Hello Professor Song: I am Changzhou Zhu * Lan 11 I checked at your PT is: PT: 16.9 seconds, INR: 1.4 seconds you told me to take warfarin a piece, I returned to Changzhou in the second hospital 17 checked PT is: 18.4 seconds, INR: 1.52 seconds and cardiac ultrasound The doctor here told me to add a quarter to eat four to five days to check again, Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang The last time I visited the examination, results, disposal plan: according to your guidance everything is very good Now the condition, want to get help: hope you take some time in a busy day to look at the ultrasound and PT hope to point out how to adjust warfarin next time Thank you! Answer: The ultrasound result is basically normal, the left ventricular size has returned to normal, the left atrium is slightly large, there is no big problem, it is recommended to review regularly, pay attention to the PT changes. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Okay. Reply: There is no relationship with digoxin. Think back to the last few days to see what is the difference in diet from before. Reply: It may be the effect of fava beans. Response: This value is acceptable. Take this medicine for a few days and check again. Response: This value is acceptable, take it according to the original dose, and extend the interval of review appropriately. Response: No need to stop the medication, just reduce the dose by a quarter tablet. Response: Let’s check again after the menstruation. Response: It is very common for PT to fluctuate, as long as it is within a range, you can add a quarter tablet, it is not a big problem. The value of this can be, it is recommended to take three-quarters of a tablet Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang Reply: It is recommended to continue to take three-quarters of a tablet Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang Reply: From your last follow-up, there is nothing wrong with her heart function, the pillow padded sleep should be a habitual problem, habitual sitting sleep should not be (should be (not sitting and breathing, right?). In addition, she should see the endocrinology department to check the hormone level in her body if she is hungry quickly. Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital, replied: The anticoagulation index is well maintained, continue to take this amount of medication. Response: Still take three-quarters of a tablet. Reply: If you feel that the anticoagulation index is stable, you can extend the interval of PT examination, but at least 2 times a year, if it is convenient, it is better to examine once every 1~3 months, after all, anticoagulation is very important for valve replacement patients. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: You are welcome, and we will contact you in time if there is anything. Reply from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: You can use it, there is no effect. Reply from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Take it according to the original dose. Reply: You need to do a cranial CT. Then let the cardiologist or cardiac surgeon listen to the sound of her prosthetic valve. Reply: There is nothing abnormal in the heart examination, so the medication will maintain the status quo. If there is any problem with the cranial CT, please ask your neurologist to take a look and see if you need to use some drugs to nourish the nervous system. Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital, replied: This result is OK, still eat according to the original dose. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: The result is OK, still take the original dose. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: This result is OK, still take it according to the original dose. The result of this can be, still eat according to the original dose Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang replied: No need to reduce, after a period of time re-check may come down again. The result is fine, still take it according to the original dose Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang replied: No problem Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang replied: The result is very good, very stable, take it according to the original dose. Patient Question: Hello Professor Song: It’s been a long time since I contacted you, the PT is fine for the last few months. Patient Question: Okay, I’ll go to do a checkup in a few days, and then I’ll have to work hard to help you look at it. Patient Question: Hello Professor Song: I’ve had a cold for many days, and today I went to check my blood clotting and blood count, and the doctor here said that I need to prescribe some medication for fear that some of the medication will be filled with warfarin. Thank you Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang replied: The blood routine is normal. There is no doctor’s prescription, only the doctor’s application for cardiac ultrasound and electrocardiogram. Patient Question: Hello Professor Song: The doctor said it is anemia to take blood medicine and then did not prescribe it, so he brought back the bill for you to see and said that the cold is well and cold is caused by anemia can be seen in the blood routine? The PT report today also came out PT23.5 seconds, INR: 1.99 Please take a look at it Thank you, and now the network how I published after the reduction of the score is not good to publish how to ah Patient Question: Professor Song Hello: the doctor said that anemia to take blood supplementation drugs after not prescribed the bill back to let you see also said that the cold is well and cold is caused by anemia on the blood routine can be seen? Today’s PT report also came out PT23.5 seconds, INR: 1.99 Please take a look thank you, Shanghai Changhai Hospital Thoracic Heart Surgery Department Song Zhigang Reply: The anticoagulation index is good, the routine blood results are anemia, she is not caused by excessive menstruation, eat some blood tonic medicine to observe and see, not to the Department of Hematology to let them treat a little. Patient Q: Okay, thank you for the blood medicine to replace the valve which class can eat ah Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang Reply: All can eat, eat a few days to check the PT results. Patient Question: Okay thank you Professor Song Patient Question: Hello Professor Song: It’s been a long time since I contacted you, I haven’t checked my PT for 2 months today and the PT report came out with PT 18.2 seconds, INR: 1.55 seems to be a bit low, right? I can take a little bit bigger pills, right? Answer: The result is fine, and the medication can be taken at the original dose. Patient Question: Okay, thank you, Professor Song. Patient Question: Hello, Professor Song: I’m coming to Shanghai next Tuesday for some business, so I’ll come to do a review. Are you working? Are we going to register with you for the review or are we going to go to the outpatient clinic? Can you help me arrange it? Reply from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Outpatient, cardiac ultrasound and PT Patient Question: Okay, thank you, just do these two items and contact you when you get the bill. Reply from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Okay. Patient Question: Hello Professor Song, are you here today? I’ll come to your office at 1:00 on the 8th floor to get the cardiac ultrasound report and send it to you, thank you for your help. The patient’s question: Hello Professor Song: Today’s PT report came out, the PT is: PT: 29.4 seconds, INR: 2.60 seconds The last time I checked with you at the end of September was 19.2 seconds INR: 1.7 seconds. The number of double grams to take half a tablet, today to check this number is high? Answer: The number is high, you can take three quarters of a tablet on every single day and one tablet on every double day. Patient Question: Hello Professor Song: Today’s PT report came out, and the PT was: PT: 17.6 seconds, INR: 1.54 seconds, and this time it is low again, right? Last month was 29.4 seconds INR: 2.6 seconds, in your instructions warfarin single day to eat a double day to eat three quarters of a tablet, ammonia body to eat half a tablet, double grams to eat half a tablet so can two days to eat a piece of every other day to eat three quarters can? Eat a month and then check. Answer from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: The result may be the effect of the recent change in diet, you can still eat the original dose, and then check again after a week. Patient Question: Is it right to take three quarters of a tablet on every single day and one tablet on every double day, and then check again a week later? Reply: Yes. Patient Question: Hello Professor Song: The PT report came out today, and the PT is: PT: 17.1 seconds, INR: 1.50 seconds. Last week was 17.6 seconds INR: 1.54 seconds, in your instructions warfarin single day to eat a double day to eat three quarters of a tablet, aminoglutethimide to eat half a tablet, double grams to eat half a tablet, every other week to check the. The diet above or according to the original way of eating not eaten, before is still normal, is to eat double grams of tablets, aminogastrin after the fluctuations of this drug is the first to eat it or after the warfarin to eat it, from the beginning to eat I was first to eat warfarin after 30 minutes and then eat double grams of tablets, aminogastrin so right hope you guidance, thank you! Answer: I have to take one tablet of warfarin a day, and Shuangke and Aminoglutethim have no effect on anticoagulation. Patient Question: Okay, thank you, eat a week and then check Patient Question: Hello Professor Song: Today’s PT report came out, the PT is: PT: 22.6 seconds, INR: 1.99 seconds this time up, this time warfarin a day a week to check the Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang Reply: Eat warfarin at the original dose. Patient Question: Okay, thank you Professor Song Patient Question: Hello Professor Song: Today’s PT report came out, the PT is: PT: 25.2 seconds, INR: 2.23 seconds, this time it went up a bit, it’s not a problem, do you need to reduce the drug? This time, I took warfarin for one tablet a day, thank you! Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: No reduction, eat according to the original dose. Patient Question: Okay, thank you Professor Song Patient Question: Hello Professor Song: Today’s PT report came out, the PT is: PT: 24.8 seconds, INR: 2.19 seconds, this time this number is good, right? The last time I was prescribed spironolactone tablets and hydrochlorothiazide tablets at your place, I ate almost all of them, I was dispensed in our pharmacy and hospital by Changzhou Pharmacy and Ruinian Pharmacy, but not by Shanghai Xinyi, is it the same and does it matter? Reply: The efficacy of the medicine is the same, and it can be used. Patient Question: New information uploaded. Reply from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Warfarin minus a quarter of a tablet. Patient Question: Hello Professor Song: I am Changzhou Zhu Meilan family, contacted you this afternoon, the PT report came out today, the PT is: PT: 37.4 seconds, INR: 3.33 seconds you told me to stop the drug for a day, eat half a tablet tomorrow to eat a week and then check, my previous report documents are here hard you help to see how these times will be so much higher, diet I have been paying attention to the recent I just did not eat any meat and vegetables are different every day, and yesterday I ate half a bowl of pork belly and pork lung soup will not be related to eat this ah other really can not figure out the front has been smooth up and down also limited. Thank you for your help in analyzing this, and the end of September last year to your place to review this year or then to come? Do you need to check twice a year, thank you! Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital, replied: Anticoagulation is related to many factors, of course, the most influential is the diet, but also does not exclude the test error, it is difficult to distinguish what causes. The occasional high anticoagulation index should not be nervous, just make a fine adjustment, your oral warfarin dose should be between half and three quarters of a tablet. Patient Question: Okay, thank you Professor Song, from today first eat half a tablet to eat a week and then check Patient Question: Hello Professor Song: eat a week half a tablet of warfarin, today’s PT report came out, the PT is 15.1 seconds, INR: 1.32 seconds this time the number of low down, today I add a quarter of a tablet to eat a week and then check it can be, next week check and then send you a look hope to get your guidance. Thank you! Answer: Yes, you should take three quarters or one tablet. Patient Question: Hello Professor Song: I’ve been eating warfarin for a week, and my PT report came out today, and the PT is 19.3 seconds, INR: 1.70 seconds. Answer: The test result is OK, still take the original dose. Patient Question: Hello Professor Song: I took one tablet of warfarin in January, and the PT report came out today, and the PT was 37.8 seconds, INR: 3.37 seconds, and this time the number is high again. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: After stopping the medication for one day, take three quarters of a tablet. Patient Question: Hello Professor Song: I have been taking three quarters of a tablet of warfarin for a week, and the PT report came out today, and the PT was 18.7 seconds, INR: 1.64 seconds. Or should I just keep taking three quarters of a tablet for a week and see. Thank you! Answer: You can try taking three quarters of a tablet on every single day and one tablet on every double day. Patient Question: Hello Professor Song: I’ve been taking warfarin for a week, and my PT report came out today, and the PT is 30.5 seconds, INR: 2.70 seconds. Thank you! Answer: You can try taking three quarters of a tablet on every single day and one tablet on every double day. Patient Question: Okay, thank you, Professor Song, today I will eat three quarters of a tablet on a single day and one tablet on a double day, and I will check again for a week. Patient Question: Hello, Professor Song: According to your advice, I will eat three quarters of a tablet on a single day and one tablet of warfarin on a double day, and the PT report came out today. I’ll see. Thank you! Answer from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Just take the medication in the same way as before, and review the pt regularly. Thank you! Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Let’s take the same dose as before. Patient Question: Hello Professor Song: The PT report this time, the PT is 23.2 seconds, INR: 2.11 seconds this year’s ultrasound report I send you to see, I do not understand how to read I compared last year in your place to do, it seems to be different from your place to check will there be a problem? I’m not sure if I’ll be able to get a review from next year. From July 30 to now on the single day you said to eat a piece of double day to eat three quarters are still normal, I sent you the first few pt also to see online has not been good speech can not be added or subtracted in accordance with the previous, the next to the third reply to help me to open a little more Thank you for your care. Response from Song Zhigang, Department of Thoracic Surgery, Shanghai Changhai Hospital: Ultrasound results are fine, warfarin is taken at the original dose. Patient Question: Hello Professor Song: It has been a long time since I contacted you, now I am checking the coagulation PT once a month, adjusting the medication according to the method you told me before to see the PT index plus or minus, I sent you the examination report from last year’s examination in November to today to see what index aspects need to be noted in the future, changes to adjust the amount of guidance guidance guidance, so far warfarin on the single day you said to eat a double day to eat three quarters. I hope to get your guidance Thank you Shanghai Changhai Hospital Thoracic Surgery Department Song Zhigang Reply: This result can be, anticoagulation strength is relatively stable, you also eat according to the original dose. Patient Question: Okay, thank you Professor Song! This time to the third reply after help me to open again thank you for your care.