心脏瓣膜置换术后早期华法林抗凝影响因素分析

Analysis of the influencing factor of early warfarin anticoagulation after heart valve replacement

目的:评估心脏瓣膜置换术后病人的早期华法林抗凝治疗中术前因素、药物因素及人口学因素等影响。方法:回顾性研究行心脏瓣膜置换手术的104例病人资料。收集与抗凝治疗相关的数据,包括基本信息(住院号、性别、年龄、体质量)、一般临床资料、合用胺碘酮、初始剂量的选择等。评估以上指标与术后早期病人华法林稳定剂量、国际标准化比值(INR)首次达标时间、治疗范围时间(TTR)的相关性。结果:女性和60岁以上病人需要华法林的稳定剂量明显低于男性和40~59岁病人(P<0.05),华法林稳定剂量随着体质量的上升而增加(P<0.05)。与单独使用华法林的病人相比,华法林与胺碘酮联用的病人花费更长的时间才能达到首次目标INR(P<0.01),并且抗凝达标率更低(P<0.05)。女性病人和初始剂量5 mg的病人TTR明显高于男性病人和初始剂量2.5 mg的病人(P<0.01)。结论:心脏瓣膜置换术后使用华法林作为抗凝治疗药物,应考虑初始剂量、药物相互作用和人口统计学因素。

Objective:To evaluate the effects of the preoperative factors,drug factors and demographic factors on the early warfarin anticoagulation after heart valve replacement.Methods:One hundred and four patients treated with heart valve replacement were retrospectively analyzed.The data related to anticoagulation treatment,which included the basic information(hospital number,gender,age and body mass),general clinical data,concomitant use of amiodarone and initial doses were collected.The correlation between the above indicators and early postoperative stable warfarin dose,first time to reach the international normolized ratio(INR)and time in therapeutic range(TTR)were evaluated.Results:The stable dose of warfarin in female patients and patients over 60 years old were significantly lower than that in male patients and patients aged 40-59 years old(P<0.05),and the stable dose of warfarin increased with the increasing of body mass(P<0.05).Compared with warfarin alone,the patients treated with warfarin and amiodarone took longer time to reach the initial target INR(P<0.01),and the rate of anticoagulation of which reaching the standard was lower(P<0.05).The TTR in female patients and patients with initial dose of 5 mg were significantly higher than that in male patients and patients with initial dose of 2.5 mg(P<0.01).Conclusions:The initial dose,drug interactions and demographic factors should be considered when warfarin is used as anticoagulant after heart valve replacement.