国人Carbomedics机械瓣膜置换术后抗凝治疗的临床观察

Anticoagulation in Chinese patients with carbomedicsmechanical prosthetic heart valves

目的 :为制定一个适合中国人机械瓣膜置换术后的抗凝强度标准提供参考。方法 :对 1 78例置换Carbomedics机械瓣膜病人 ,按INR(1 .4～ 2 .0 )标准抗凝 ,通过术后随访 ,比较有并发症与无并发症组病人间INR均值有无差异以及术后不同时期INR的波动情况。结果 :本组发生出血 2 2例 (5 .83%病人 年 ) ,栓塞 1例 (0 .2 6 %病人 年 ) ,晚期死亡 3例 (0 .79%病人 年 ) ,最终INR 1 .6 8± 0 .38,口服华法林剂量 (2 .34± 0 .80 )mg ,术后 5个时间点INR数据差异均有统计学意义 (P <0 .0 5 ) ,其中第 1月INR 1 .75± 0 .2 7,与其余 4个时间点INR值差异均有统计学意义 (P <0 .0 5 ) ,而其余 4个时间点INR值之间差异均无统计学意义 (P >0 .0 5 )。结论 :对于机械瓣膜置换术后的中国人 ,出血是抗凝治疗的首要并发症 ,其发生率远高于栓塞发生率。INR 1 .4～ 2 .0的强度抗凝可明显减少出血发生率 ,同时可预防栓塞发生。术后第 1月INR的波动最大 。

Objective To provide some references for defining the Chinese optimal intensity of anticoagulation after mechanical heart valve prostheses replacement. Methods For the 178 patients with carbomedics mechanical prosthetic heart valves, the means of INR were compared between the patients with complications and those without complications at the standard of INR1.4～2.0. Also, the variations of INR were compared among different follow ups. Results During the follow up, 22 hemorrhagic and 1 thromboembolic complication occurred. The total linearized rate of anticoagulation related hemorrhage was 5.83%pty. The total linearized rate thromboembolism was 0.26%pty. The late mortality was 0.79%pty(3 cases ). The final mean INR was 1.68±0.38. The final mean oral warfarin dose was 2.34±0.80 mg. The differences of variations of INR in five periods were significant (F=5.072,P <0.05). The mean INR in the first month of follow up was 1.75±0.27. Conclusion For Chinese patients with mechanical prosthetic heart valve, hemorrhage is the principal complication,the ratio of which is much higher than that of thromboembolism. The low dose anticoagulation (INR1.4 2.0) could remarkably decrease hemorrhagic events as effectively as prevent the thrombolic events. Moreover the INR is the most unstable in the first month of follow up, so re examination for the patients in the first month after the operation is vitally important.