BACKGROUND AND AIM OF THE STUDY: @entity1 with mechanical heart valves implanted at four cardiothoracic centers were followed up in a hospital in Eastern India. Despite successful surgery and regular hospital visits, long-term survival was compromised by anticoagulation-related complications. METHODS: Systematic analysis revealed under-anticoagulation in most @entity1 . @entity715 risk in 80 @entity1 on regular follow up from 1989 to 1997 was 8.68 per 100 @entity1 years (pt-yr). The incidence of both @entity715 was reported as less than two per 100 pt-yr, when prothrombin time was consistently in the range of INR 2.5 to 3.9. In targeting this low event rate, impediments to optimum anticoagulation in the local set-up were identified. International Normalized Ratio (INR) was introduced to report prothrombin time (PT). @entity1 and doctors were educated about drug and diet interactions with oral anticoagulants (OAC) and the early features of valve @entity715 . Treatment protocols were evolved. The impact of the remedial measures was studied in 81 @entity1 (64 old, 17 new) over a total of 254 pt-yr of follow up, from 1998 to 2001. RESULTS: @entity715 risk was reduced from 8.68 to 5.12 per 100 pt-yr, while non-fatal @entity548 events increased from 0.28 to 1.96 per 100 pt-yr. Due to early recognition of occlusive @entity715 and institution of fibrinolytic therapy, fatal events were reduced from 3.8 per 100 pt-yr to none for four consecutive years (statistically significant at 99% CI). CONCLUSION: The clinical audit proved to be a valuable tool for understanding the problems in health care delivery, and bringing about improvement.

Reduction of mechanical heart valve XXXX through a clinical audit.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity715 :: ('MESH:D013927', 'Disease') :: ['prosthetic valve thrombosis', 'thrombosis', 'thrombotic and bleeding complications', 'Thrombosis'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding']
@entity715 :: (MESH:D013927,Disease) :: ['thrombosis']
