心脏瓣膜置换术后华法林抗凝治疗的单中心临床应用调查  

Clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement:a single center-based survey

作　　者：刘媛[1] 余细勇[2] 钟诗龙[2] 杨敏[2] 谭虹虹[2] 费洪文[3] 陈纪言[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所心内科,广东广州510080 [2]广东省人民医院广东省心血管病研究所医学研究中心,广东广州510080 [3]广东省人民医院广东省心血管病研究所心脏B超室,广东广州510080

出　　处：《南方医科大学学报》2010年第10期2242-2245,共4页Journal of Southern Medical University

基　　金：国家自然科学基金(30772620);广东省医学科学技术研究基金(A2007048)~~

摘　　要：目的考察心脏瓣膜置换术后华法林抗凝治疗的单中心临床应用现状,比较华法林采用不同抗凝强度治疗的疗效和安全性。方法入选广东省人民医院2000～2008年瓣膜置换术后长期口服华法林抗凝治疗的中国患者845例,追踪随访患者一般资料、临床资料、用药方案、国际标准化比值(INR)值和心脏B超结果,观察血栓栓塞并发症及出血等不良反应的发生率。结果 845例患者均为汉族,广东人占88.04%,华法林的日平均维持剂量为2.92±0.88mg/d,术后多次测定INR值的中位数为2.09±0.39,44.62%的患者采用低强度抗凝治疗,INR维持在1.5～2.0范围;56.45%患者采用标准强度抗凝,INR维持在2.0～3.0。血栓事件总的发生率为4.14%。14(1.66%)例患者发生严重出血不良反应,其中消化道出血最常见。出血事件与置入心脏瓣膜类型相关,机械瓣置换术出血事件较生物瓣置换增加有显著性意义。低强度抗凝与标准强度抗凝比较,血栓栓塞并发症及严重出血不良反应的发生率差异无显著性意义。结论中国人群低强度抗凝治疗的有效性和安全性与标准抗凝相当,华法林抗凝治疗INR比值维持在1.8～3.0范围内是安全有效的。Objective To investigate the clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement and compare the effect and safety of different anticoagulant intensities.Methods A total of 845 Chinese patients receiving oral warfarin for anticoagulant treatment after prosthetic heart valve replacement in Guangdong General Hospital between 2000 and 2008 were enrolled in this survey.The general data,clinical data,medications,international normalized ratio（INR） and results of echocardiogram of these patients were followed up to observe the incidence of complication of thrombo-embolism and such adverse effect as hemorrhage.Results All the patients were of Han nationality,and Cantonese accounted for88.04%.The daily mean maintenance dose of warfarin was 2.92？？.88 mg in these patients with a median INR of 2.09？？.39.Of these patients,44.62% received low-intensity anticoagulant treatment with warfarin with the INR maintained between 1.5 and 2.0,and 56.45% had standard anticoagulant intensity with the INR maintained between 2.0 and 3.0.The total incidence of thrombo-embolism was 4.14%.Severe hemorrhage occurred in 14 cases（1.66%）,most frequently in the alimentary tract.The events of hemorrhage were correlated to the type of prosthetic heart valve replacement,occurring more frequently in patients with mechanical prosthetic heart valve replacement than in those with biological ones.No significant difference was found in the incidence of thrombo-embolism and server hemorrhage between the two groups receiving low and standard intensity therapy anticoagulant.Conclusion The effect and safety of low-intensity anticoagulant treatment are comparable to that of standard intensity treatment in Chinese Han patients,and anticoagulation treatment with warfarin is effective and safe to maintain the INR between 1.8-3.0.

关 键 词：人工瓣膜置换术 华法林 抗凝 国际标准比值 

分 类 号：R654.2[医药卫生—外科学]