心脏瓣膜置换术后服用华法林致出血的危险因素分析

Risk Factors of Warfarin Bleeding after Heart Valve Replacement

目的 分析人工心脏瓣膜置换术后患者服用华法林致出血的危险因素。方法 回顾性选取2018年8月—2021年8月在泉州市第一医院抗凝联合门诊随访的人工瓣膜置换术后服用华法林抗凝治疗的384例患者,收集患者基本资料(包括性别、年龄、体质量、华法林剂量和合并疾病等)。根据是否有出血并发症分为出血组和非出血组,进行单因素及多因素Logistic回归分析。结果 两组INR值和TTR值(INR在治疗范围内的时间)对比,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示:高INR值为引起出血的危险因素(OR=20.58,95%CI为6.593~64.236),TTR为引起出血的保护因素(OR=0.916,95%CI为0.880~0.954),TTR越高出血风险越低。结论 高INR值是人工心脏机械瓣膜置换术后服用华法林致出血的相关危险因素。

Objective To analyze the risk factors for bleeding after artificial heart valve replacement with warfarin.Methods 384 patients who took warfarin anticoagulation treatment after prosthetic valve replacement were retrospectire selected in the anticoagulation clinic of Quanzhaou Fist Hospital from August 2018 to August 2021,and the basic data of the patients(including gender,age,weight,warfarin dose and concomitant diseases)were collected.According to whether there are bleeding complications,the patients were divided into bleeding group and non-bleeding group,and the single factor and multiple factor logistic regression analysis was performed.Results The difference between the INR value and TTR value(the time of INR within the treatment range)between the two groups was statistically significant(P<0.05).Multivariate logistic regression analysis showed that high INR value was the risk factor of bleeding(OR=20.58,95%CI 6.593-64.236),and TTR was the protective factor of bleeding(OR=0.916,95%CI 0.880-0.954).The higher the TTR,the lower the bleeding risk.Conclusion High INR is a risk factor for bleeding after mechanical valve replacement with warfarin.