心脏机械瓣膜置换术后华法林抗凝的调整策略

Strategy of warfarin adjustment after mechanical heart valve replacement

目的：研究心脏机械瓣膜置换术后华法林抗凝的调整策略及年龄、性别、体重与华法林抗凝剂量、疗效的关系。方法：回顾192例心脏机械瓣膜置换术后服用华法林抗凝患者的临床资料,总结华法林抗凝调整国际标准化比值（INR）的方法,分析年龄、性别、体重和华法林剂量、INR值的关系,观察其抗凝效果及主要不良反应。结果：1例患者因过量服用华法林出现颅内出血死亡,1例过量出现严重皮下出血及鼻出血,1例出现腔隙性脑梗死,2例单用华法林效果不佳,合用拜阿司匹林后INR可调整到目标范围,其余患者效果较好,无严重出血及血栓形成。结论：心脏机械瓣膜置换术后华法林抗凝维持剂量个体差异较大,与年龄、性别、体重无关;抗凝治疗维持INR在1.8-2.5间较为适宜,不增加出血及血栓风险。

Objective：To study the strategy of warfarin anticoagulation and the relationship between age,gender,body weight and the amount,efficacy of warfarin,after mechanical heart valve replacement.Methods：All the 192 patients who had undergone valve replacement in our hospital were involved in this study.Sum the method of warfarin anticoagulation to adjust the international normalized ratio（INR）.Analysis the clinical data of age,gender,body weight,warfarin dose and its INR,and observe its anticoagulant effects and major adverse events.Results：One case of death was due to intracranial hemorrhage using overdose of warfarin,1 case of complication was due to excessive subcutaneous bleeding and severe nasal bleeding,1 patient had lacunar brain stem,2 patients were ineffective using of warfarin alone,but after combination with aspirin the INR could adjust to the target range.Rest of the patients had a good result,with no serious bleeding and thrombosis.Conclusion：There was great individual difference in the doses and coagulation effects of warfarin,independent with age,gender and body weight.To maintain INR at 1.8 to 2.5 is appropriate,which does not increase the risk of bleeding and thrombosis.