The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

Introduction: Although, the effects of patient education on the effective anticoagulant management, among patients undergoing heart valve replacement with mechanical prosthesis, have been reported, the evidence of this association remains inconclusive. Aim: To investigate the effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement. Methods: A quasi-experimental study was conducted. Patients were allocated to a) a control group (n=100), including those who received the usual education on oral anticoagulants, and b) an intervention group (n=100), with those who attended a nurse-led education program, postoperatively, including verbal courses and written material through an education booklet. We investigated the incidence of hemorrhagic and thromboembolic episodes 3 months after patients' hospital discharge. Patients' socio-demographic and clinical characteristics were obtained using a structured short questionnaire and through the medical and nursing patient records review. Patients' follow up data were collected via phone interviews. Results: The baseline characteristics were similar for both groups. Patients who received nurse-led education on oral anticoagulant therapy had a significantly lower 3-month incidence of hemorrhagic episodes compared with controls (1% vs 14%, p<0.001). However, we found insignificant differences on the 3-month incidence of thromboembolic episodes between the two groups. Conclusion: The implementation of a nurse-led education program on oral anticoagulants management failed to show effectiveness on the 3-month incidence of thromboembolic episodes, however, this educational intervention seems to be superior to the usual patient education, leading to significantly lower occurrence of hemorrhagic episodes.