心脏瓣膜置换术术后应用质子泵抑制剂对华法林初期抗凝效果的影响分析

Influence of proton pump inhibitors on the initial anticoagulant effect of warfarin after cardiac valve replacement

目的探讨心脏瓣膜置换术术后采用质子泵抑制剂(PPI)对华法林初期抗凝效果的影响。方法120例心脏瓣膜置换术术后接受华法林初期抗凝治疗的患者,基于是否服用PPI分为对照组、奥美拉唑肠溶胶囊组、泮托拉唑钠肠溶胶囊组,每组40例。对照组术后服用华法林抗凝,未服用PPI;奥美拉唑肠溶胶囊组在华法林抗凝治疗基础上给予奥美拉唑肠溶胶囊治疗,泮托拉唑钠肠溶胶囊组在华法林抗凝治疗基础上给予泮托拉唑钠肠溶胶囊治疗。比较三组患者术后国际标准化比值(INR)、停药率、INR>3的次数、4周华法林的平均日剂量、住院期间INR控制情况及不良反应发生率。结果治疗前、治疗第1周后、治疗第2周后,三组患者INR比较差异无统计学意义(P>0.05);治疗第1、2、3、4周后,三组患者INR均高于本组治疗前,差异有统计学意义(P<0.05)。治疗第3、4周后,对照组INR分别为(2.33±0.14)、(2.50±0.15),奥美拉唑肠溶胶囊组分别为(2.49±0.18)、(2.69±0.21),泮托拉唑钠肠溶胶囊组分别为(2.38±0.19)、(2.51±0.18)。治疗第3、4周后,奥美拉唑肠溶胶囊组INR明显高于对照组、泮托拉唑钠肠溶胶囊组,且三组患者比较差异有统计学意义(P<0.05)。奥美拉唑肠溶胶囊组停药率明显高于对照组、泮托拉唑钠肠溶胶囊组,且三组患者比较差异有统计学意义(P<0.05);三组患者INR>3的次数、4周华法林的平均日剂量和INR控制在目标范围内的比例比较差异无统计学意义(P>0.05)。三组患者心血管事件和消化道出血发生率比较,差异无统计学意义(P>0.05)。结论心脏瓣膜置换术患者术后使用奥美拉唑肠溶胶囊可强化华法林初期抗凝的效果,减少华法林使用量,但是联合使用时应对INR进行密切监测。也可协同服用泮托拉唑钠肠溶胶囊,其对华法林初期抗凝效果影响较小,确保抗凝治疗顺利进行。

Objective To discuss the influence of proton pump inhibitors(PPI)on the initial anticoagulant effect of warfarin after cardiac valve replacement.Methods A total of 120 patients who received warfarin initial anticoagulation after cardiac valve replacement were divided into control group,omeprazole enteric-coated capsule group and pantoprazole sodium enteric-coated capsule group based on whether they took PPI or not,with 40 cases in each group.The control group received warfarin anticoagulation after surgery,but did not take PPI;omeprazole enteric-coated capsule group was given omeprazole enteric-coated capsule on the basis of warfarin anticoagulant therapy,and pantoprazole sodium enteric-coated capsule group was given pantoprazole sodium enteric-coated capsule on the basis of warfarin anticoagulant therapy.The postoperative International Normalized Ratio(INR),drug withdrawal rate,frequency of INR>3,average daily dose of warfarin in 4 weeks,INR control and adverse reactions during hospitalization were compared among the three groups.Results There was no statistically significant difference in INR among the three groups before treatment,after the 1st week of treatment and after the 2nd week of treatment(P>0.05).After the 1st,2nd,3rd and 4th weeks of treatment,INR in three groups was higher than that before treatment in this group,and the difference was statistically significant(P<0.05).After the 3rd and 4th weeks of treatment,INR were(2.33±0.14)and(2.50±0.15)in control group,(2.49±0.18)and(2.69±0.21)in omeprazole enteric-coated capsule group,and(2.38±0.19)and(2.51±0.18)in pantoprazole sodium enteric-coated capsule group.After the 3rd and 4th weeks of treatment,INR of omeprazole enteric-coated capsule group was significantly higher than that of control group and pantoprazole sodium entericcoated capsule group,and the difference was statistically significant(P<0.05).The drug withdrawal rate of omeprazole enteric-coated capsule group was significantly higher than that of control group and pantoprazole sodium enteric-coated capsule group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the frequency of INR>3,average daily dose of warfarin in 4 weeks and the proportion of INR controlled within the target range among the three groups(P>0.05).There was no statistically significant difference in the incidence of cardiovascular events and gastrointestinal bleeding among the three groups(P>0.05).Conclusion For patients with cardiac valve replacement,postoperative use of omeprazole enteric-coated capsules can enhance initial anticoagulant effect of warfarin and reduce the use of warfarin,but INR should be closely monitored when used in combination.Pantoprazole sodium enteric-coated capsules can also be taken together,which has little impact on the initial anticoagulant effect of warfarin to ensure the smooth progress of anticoagulant treatment.