[Compliance problems in the oral anticoagulant treatment of patients wearing heart valve prostheses].

The need for and the efficacy of oral anticoagulation in patients who have undergone prosthetic valve replacement is widely demonstrated. The aim of this study is to assess how dicumarolic treatment is understood and actually accomplished by patients. A 30-question form was sent to 292 patients discharged following valve replacement, 5 to 45 months (mean: 19 months) after surgery. All of the 220 patients who submitted their answers, were effectively on oral anticoagulants. More than 95% of them knew exactly the suggested optimal prothrombin activity range. About one fifth of the patients has laboratory tests performed weekly, and nearly one half does so every 10-15 days. One fourth of the patients does not consult a physician for decision making about drug dosage. Difficulties in maintaining anticoagulation in the desired range, occurring at least once every month, are reported by 18.6% of patients. Haemorrhage was never experienced by 83.18%; in one single case thromboembolism was apparent. A few patients (2.27%) think of oral anticoagulation as a "difficult" treatment. We conclude that complete information is needed, about the aim, the modality, and the potential hazard of oral anticoagulation, so that a better understanding of the treatment and an improved cooperation between physicians and patients can result in benefits, in terms of the safety and efficacy of life-long antithrombotic therapy.