International Normalized Ratio Self-Management Lowers the Risk of Thromboembolic Events After Prosthetic Heart Valve Replacement Thomas Eitz, MD, Soren.

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International Normalized Ratio Self-Management Lowers the Risk of Thromboembolic Events After Prosthetic Heart Valve Replacement Thomas Eitz, MD, Soren Schenk, MD, Dirk Fritzsche, MD, Andreas Bairaktaris, MD, Otto Wagner, MS, Heinrich Koertke, MD, Reiner Koerfer, MD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 949-955 (March 2008) DOI: 10.1016/j.athoracsur.2007.08.071 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 International normalized ratio (INR) values stratified to ranges below the target range (<2.5), within the target range (2.5 to 4.5), and above the target range (>4.5) in patients with conventional (Conv’l, patterned bar) and self-management (Self- INR, filled bars). (*p < 0.001.) The Annals of Thoracic Surgery 2008 85, 949-955DOI: (10.1016/j.athoracsur.2007.08.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Change of international normalized ratio (INR) values between two consecutive measurements in patients with conventional INR management (Conv’l, patterned bar) and self-management (Self-INR, filled bar.) (** indicates p < 0.001). (B) Change of INR values in relation to times of no adverse event vs times of 4 weeks before an adverse event (AE) of thromboembolism or bleeding. The Annals of Thoracic Surgery 2008 85, 949-955DOI: (10.1016/j.athoracsur.2007.08.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Freedom from adverse events, including thromboembolism (TE) and bleeding, after heart valve replacement. Squares represent percentages of patients without adverse events at the time after valve replacement (noted on horizontal axis), and the vertical bars are asymmetric 68% confidence intervals for these estimates (equivalent to ± 1 standard error). Numbers in parenthesis indicate patients free of adverse events. The solid line, enclosed within dashed 68% confidence limits, is a parametric estimate; from this is derived the risk of adverse events (hazard function) by month shown in the inset. The Annals of Thoracic Surgery 2008 85, 949-955DOI: (10.1016/j.athoracsur.2007.08.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Freedom from adverse event effect of self-managed international normalized ratio (INR) management (Self) vs conventional INR management (Conv’l), as derived from the hazard function. Other related indicators were fixed during the modeling process (that is, parameters were specified/set/entered into regression equation of hazard model) (INR, 2.9; body surface area, 1.89; single-valve replacement). The dashed lines represent 68% confidence limits. The Annals of Thoracic Surgery 2008 85, 949-955DOI: (10.1016/j.athoracsur.2007.08.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions