Summary
This study evaluated the advantage of an anticoagulation clinic in terms of the improvement
of the clinical quality of oral anticoagulation (i.e. prevention of thromboembolism
and low rate of hemorrhagic complications). The incidence of thromboembolic events
and major hemorrhagic complications was assessed in a series of 271 patients on oral
anticoagulation for mechanical heart valve prosthesis before and after their enrollment
in our anticoagulation clinic from January 1987 to December 1990. Risk factors for
hemostatic events were also analyzed. The incidence of major hemostatic complications
was significantly lower when patients attended the clinic: 1.0 vs 4.9%/pt-yr for hemorrhage
and 0.6 vs 6.6%/pt-yr for thrombosis. This depended on three main factors: better
dose regulation of warfarin, continuous patient education and early identification
of clinical conditions potentially at risk for thrombosis and hemorrhage. Only previous
hemorrhagic or thromboembolic events were recognized as major risk factors for hemostatic
complications.
In conclusion, our study shows that an anticoagulation clinic offers a real advantage
to patients with mechanical heart valve prosthesis in terms of prevention of thromboembolic
events and hemorrhagic complications.
