心脏机械瓣膜置换术后患者1071例低强度抗凝报告

Low intensity anticoagulation in patients with mechanical cardiac valve replacement:a report of 1071 cases

目的评价心脏机械瓣膜置换手术(MHVR)患者低强度抗凝治疗的有效性及安全性。方法从2012年1月-2016年5月对1 071例MHVR患者进行门诊监测,将INR控制在1.5~2.5范围,统计血栓、出血事件发生率和INR值。结果门诊抗凝治疗患者1 071例共计随访8 826例次,随访时间1~47个月,平均8.24月。INR平均值1.99±0.69,中位值1.89,共发生抗凝相关不良事件59例次(0.67%),其中血栓相关事件10例次(0.11%),无死亡病例,有5例患者超过3个月未监测INR,有2例超过半年未监测INR。出血相关事件49例次(0.56%),死亡3例(0.28%),有27例超过3个月未监测INR,有9例超过半年未监测INR,有15例发生严重出血超过3 d才到医院救治,其中3例患者因大出血诱发心力衰竭、肾功能衰竭和凝血功能障碍而导致死亡。本中心INR监测值为1.99±0.69。结论 MHVR患者实施低强度抗凝治疗是安全可行的,需要加强患者教育及规范的定期监测。

Objective To investigate the efficacy and safety of low intensity anticoagulation therapy for patients with mechanical heart valve replacement（MHVR）.Methods There were 1 071 patients with MHVR in the hospital were followedup from January 2012 to May 2016,INR controled in the 1.5-2.5 range.The dosage of warfarin,monitoring frequency,INR,hemorrhage and embolism were recorded.Results Anticoagulant therapy in 1 071 patients undergoing cardiac valve replacement surgery,8 826 records were collected.The longest follow-up time was 47 months,the shortest time was 1 months（mean,8.24 months）.The average value of INR was 1.99 ± 0.69,with a median value of 1.89,the total anticoagulation related complication occurred in 59 cases,the incidence rate was 0.67%,of which 10 cases of thrombosis related events,the incidence rate was 0.11%,no death case,5 patients more than 3 months without INR monitoring,there are 2 cases of more than half a year without monitoring INR.Bleeding related events in 49 cases,the incidence was 0.56,3 cases died,the incidence was 0.28,27 cases of more than 3 months without INR monitoring,there are 9 cases of more than half a year without monitoring INR,15 cases had severe hemorrhage more than 3 days＇ treatment to the hospital,among which 3 cases were due to failure and coagulopathy induced heart failure renal function,bleeding and lead to death.The INR monitoring value of this center is 1.99 ± 0.69.Conclusion Low intensity anticoagulation therapy is safe and feasible for patients with MHVR and needs to be strengthened with patient education and standardized regular monitoring.