心脏机械瓣膜置换术后华法林低强度抗凝疗效观察

Efficacy of warfarin low intense anticoagulation after heart valve replacement

目的探讨安徽地区汉族人心脏机械瓣膜置换术后华法林低强度抗凝应用于患者的安全性,为瓣膜置换术后患者给予最佳的华法林抗凝剂量及最佳的INR控制标准提供参考。方法对安徽医科大学第一附属医院2010年1月至2013年1月期间509例安徽省地区汉族人群人工机械瓣膜置换术后的患者给予华法林低强度抗凝治疗。随访期间,记录其PT、INR值及华法林剂量。统计出血及血栓、栓塞等不良事件的发生。结果失访及数据不完整的有40例,数据较完整的有469例,随访1～37个月,平均（18.13±6.02）月,总随访1 960.8人年。男211例,女258例,平均年龄（40.52±13.38）岁,其中行MVR 268例,AVR 115例,DVR 86例。所换瓣膜均为双叶机械瓣膜,其中153枚St.Jude Regent瓣膜,291枚CarboMedics瓣膜,111枚国产GKS瓣膜。结果平均INR为2.11±0.56,平均华法林剂量为（3.124±2.4）mg。共有47例抗凝相关并发症,其中出血事件37例（发生率为1.89%pt-y）,血栓、栓塞事件有10例（发生率为0.51%pt-y）。另外,5例死亡,与抗凝相关有3例。术前患者共有316例合并房颤,43例合并左房血栓。结论安徽省人群瓣膜置换术后患者INR控制在1.8～2.2是合适的,可以有效控制血栓、栓塞及出血等并发症的发生。合并房颤患者及行DVR的患者的抗凝相关并发症发生率较高,此类患者应加大复查频次,及时调整华法林剂量。

Objective To evaluate the safety of warfarin low intensity anticoagulation after mechanical heart valve replacement in Anhui Han population,and to identify optimum international normalized ratio（INR） levels and required warfarin doses and anticoagulation-related complications in patients following mechanical heart valve replacement.Methods We studied 509 patients who underwent mechanical valve replacement with low intensity anticoagulation at the 1st Affiliated Hospital of Anhui Medical University from January2010 to January 2013.During the follow-up,we recorded the prothrombin time（PT）,international normalized ratio（INR） and oral warfarin dose and thromboembolism/hemorrhage complications.Results Complete data were obtained of 469 patients which were followed up for an average of 18.13 ± 6.02 months（range 1 ～ 37 months）,totally followed up 1 960.8p-ys.Two hundred and eleven were males and two hundred and fifty-eight were females with a mean age of 40.52 ± 13.38 years.A total of 268 patients had MVR,115 patients AVR,and 86 patients DVR.Valves implanted were all bileaflet,of which 153 were St.Jude Regent,291 CarboMedics,and 111 GKS.Average INR was 2.11 ± 0.56,and warfarin dose was（3.124 ± 2.4） mg.There were 47 cases of anticoagulation-related complications,of which 37 were anticoagulation-related hemorrhage（1.89% pt-y）,and 10 were anticoagulation-related thromboembolism（0.51% pt-y）.And 5 patients died,of which 3 were anticoagulation related.Among all of these patients,316 were complicated by atrial fibrillation and 43by left atrial thrombosis.Conclusions Anticoagulation for mechanical heart valve replacement can be managed with INR levels within the range of 1.8 ～ 2.2,which can prevent hemorrhagic and thromboembolic events.Patients with atrial fibrillation and double valve replacement have higher anticoagulation-related morbidity,which should have higher frequency of review and timely adjustment of warfarin dose.