机械瓣膜置换术后低强度抗凝的初步研究

The study of low intense anticoagu lation of patients after heart valve replacemint

将 5 0名风湿性心脏瓣膜病患者按国际标准化比值 (INR)分为三组 ,并于术后定时分别检测凝血酶原时间 (PT)及相应的 INR、D-二聚体 (D-dimer)浓度、抗凝血酶 活度 (AT- :C) ,并监测其术后出血及血栓形成发生率。结果 :机械瓣膜置换术 (HVR)后 ,INR控制于 1.3～ 2 .0范围内即可保持 D-dimer浓度、AT- :C,与对照组无显著差异 (P>0 .0 1)。采取高的 INR值虽可以降低 D-dimer浓度、提高 AT- :C,但差异不显著 (P>0 .0 1) ,而出血发生概率明显增加 (P<0 .0 1)。三组术后并未出现血栓形成 ,说明风湿性心脏瓣膜病患者机械瓣膜置换术后行低强度抗凝是可行的 ,术后采取 INR控制于 1.3～ 2 .0的低强度抗凝是安全的。

patients who received oral warfarin anticoagulation after heart valve replacement (HVR) were followed for at least 6 months and were divided into 3 groups according to their INR values. Each patient's blood sample was detected regularly for PT, INR, D dimer and AT Ⅲ∶C. The results showed that in the group A, INR kept 1.3～1.7, D dimer and AT Ⅲ∶C values were as same as that of the control group(P>0.01). In the group B, INR kept 1.7～2.0, AT Ⅲ∶C values were slightly higher than that of group C, but not significant. The rate of bleeding accidents of group B was significantly higher than that of group A. No thrombolic accident was reported in each group. A low intense anticoagulation with the INR between 1.3～2.0 is safe for the patients who receive oral warfarin anticoagulation after HVR.