Why the study?
Heart valve replacement requires long-term anticoagulation, but poor adherence can lead to thrombosis and embolism; evidence-based guidance was sought to improve anticoagulation adherence management.
Does structured anticoagulation adherence management improve medication adherence, INR monitoring status, postoperative complication rates, and patient satisfaction in adult patients on oral anticoagulants after cardiac valve replacement?
Does structured anticoagulation adherence management improve medication adherence, INR monitoring status, postoperative complication rates, and patient satisfaction in adult patients on oral anticoagulants after cardiac valve replacement?
This evidence summary synthesizes clinical guidelines, systematic reviews, and trials into actionable best-practice statements across four dimensions to help healthcare professionals improve oral anticoagulation adherence and clinical outcomes in adults following cardiac valve replacement.
Supports multi-dimensional adherence strategies post-valve replacement; extends guidelines with synthesized RCT and observational evidence.
Background: Heart valve replacement is one of the primary treatments for valvular heart disease. Postoperatively, patients require long-term anticoagulation therapy to prevent life-threatening thromboembolic events. However, poor patient adherence to anticoagulation can lead to complications such as thrombosis and embolism, adversely impacting patient prognosis. This study aimed to systematically search for the best available evidence on anticoagulation adherence management to provide evidence-based guidance for the clinical practice concerning adult patients after heart valve replacement. Methods: Following the "6S" evidence resource model, evidence retrieval was conducted in a top-down manner, collecting relevant guidelines, best practices, evidence summaries, systematic reviews, and expert consensuses. The search period was limited to databases from January 1, 2015, to May 31, 2025. Two evidence-trained researchers independently appraised the quality of the included literature. Evidence was then extracted and summarized according to the JBI evidence grading and recommendation system. Results: A total of 13 articles were finally included, comprising 5 clinical decisions, 1 evidence summary, 3 guidelines, 2 systematic reviews, 1 expert consensus, and 1 randomized controlled trial. Eighteen best evidence statements were summarized from four dimensions: symptom assessment, monitoring modalities and methods, quality control and management, and patient education. Conclusion: This study summarized the best evidence for anticoagulation adherence management after heart valve replacement across four dimensions. This can provide guidance for clinical or community healthcare professionals in developing and implementing interventions and practice programs to improve patient adherence to anticoagulation, thereby improving clinical outcomes and quality of life for patients post-heart valve replacement.
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Peng et al. (2025) studied this question.
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