华法林联合肝素在机械瓣膜置换术后抗凝治疗中的应用

Clinical study of anticoagulation with warfarin and heparin in patients after mechanical valve replacement

目的 探讨机械瓣膜置换术后不同抗凝方法的使用对抗凝效果的影响.方法 回顾性分析2005年10月至2008年6月在我院行机械瓣膜置换术的患者172例,分为2组：华法林组（单纯应用华法林抗凝者）和肝素组（术后应用华法林联合肝素抗凝者）.记录2组的手术方法、抗凝方法、抗凝监测指标及相关并发症发生情况,分析比较2组患者的抗凝效果.结果 华法林组：住院期间出现1例脑栓塞,发生率为1.1%;1例下消化道出血,发生率为1.1%;其余患者抗凝效果满意.肝素组：未出现抗凝相关并发症,口服华法林抗凝指标达到稳定的时间较华法林组短,差异有统计学意义（8 d±3 d比11 d±4 d,P＜0.01）.进一步应用直线回归方程引入性别、年龄、体重等可能潜在的混杂因素进行调整得出：应用肝素较未用肝素组华法林抗凝指标达到稳定的时间短2.11 d,差异有统计学意义（P＜0.01）.结论 机械瓣膜置换术后应用华法林联合肝素抗凝安全有效.

Objective To investigate the effect of different methods of anticoagulation after mechanical valve replacement. Methods Totally 172 cases of mechanical valve replacement performed from October 2005 to June 2008 were divided into two groups and then analyzed retrospectively. Patients on warfarin and heparin were classified as the heparin group while those on warfarin alone were classified as the warfarin group. The operation, anticoagulation, anticoagulation index and associated complications were recorded to compare the effect of anticoagulation between two groups. Results warfarin group： the overall anticoagulation effect was satisfactory except for cerebral embolism （n= 1, 1.1%） and lower gastrointestinal hemorrhage （n= 1, 1.1%） during hospitalization. Heparin group： no anticoagulation-related complication was found. The time to reach stable warfarin anticoagulation was shorter than the warfarin group and difference was of significance （8 d ± 3 d vs 11 d ± 4 d,P 〈 0.01）. Ater adjustment of potential confounding factors such as age, gender, weight by linear regression analysis, the result showed that, the time to reach stable warfarin anticoagulation was shortened than the warfarin group by 2.11 days. Statistical significance of difference was observed between two groups （P 〈 0.01）. Conclusion It is both safe and effective to anticoagulate the patients after mechanical valve replacement with warfarin and heparin.