主动脉瓣机械瓣置换术后停抗凝治疗的长期随访  

Long-term Outcomes of Patients without Anticoagulation Therapy after Prosthetic Aortic Valve Replacement

作　　者：黄焕雷[1] 刘小元 卢聪[1] 郭惠明[1] 肖学钧[1] 吴若彬[1] 陈寄梅[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所 广东省人民医院广东省医学科学院,广州510100 [2]解放军军乐团卫生科,北京100089

出　　处：《中国胸心血管外科临床杂志》2014年第2期151-155,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑计划项目(2011BAI11B18);广东省自然科学基金项目(S2011010005493)~~

摘　　要：目的 总结单纯主动脉瓣机械瓣置换术后长期停用华法林抗凝治疗的临床结果，探讨在主动脉瓣置换术后的低危患者采用短期抗凝的可行性。 方法 对1996～1999年在广东省人民医院行手术治疗主动脉瓣机械瓣置换3年后长期停用华法林抗凝治疗的7例患者进行定期跟踪随访，其中男6例、女1例，年龄25～75 （40.0±11.4）岁。患者在术后前3年口服华法林抗凝，3年后停服（停抗凝组）。并从坚持口服华法林抗凝治疗的患者中，选取同时段行主动脉瓣机械瓣置换的患者15例作为对照组（抗凝组），停抗凝组和抗凝组在华法林抗凝期间国际标准化比值（INR）控制在1.8～2.5之间。比较两组患者生存率和严重不良事件的发生率差异。 结果 停抗凝组失访1例，无血栓栓塞和死亡，人工瓣膜无血栓形成，心功能分级（NYHA）均为Ⅰ级。抗凝组失访3例，心功能分级（NYHA）Ⅰ级11例，Ⅱ级1例。在随访期间因抗凝引起的严重出血事件3例，均为消化道出血。突发大量吐血死亡1例，猝死1例。两组10年生存率分别为100.0%和86.7%。 结论 单纯行主动脉瓣人工机械瓣置换的低危患者，有可能采用仅在术后前3年口服华法林作短期抗凝治疗，3年后停用口服抗凝药物的治疗方案。Objective To investigate long-term outcomes of patients without warfarin anticoagulation after isolated prosthetic aortic valve replacement （AVR）,and evaluate the feasibility of short-term instead of lifelong anticoagulation therapyfor low-risk AVR patients. Methods Seven patients who underwent prosthetic AVR in Guangdong General Hospital between1996 and 1999 but discontinued warfarin anticoagulation 3 years after surgery were regularly followed up. There were 6 male and 1 female patients with their age of 25-75 （40.0±11.4） years. These patients received warfarin anticoagulation during thefirst 3 years after surgery but discontinued oral anticoagulant 3 years after surgery （discontinued anticoagulation group）.Fifteen patients who underwent prosthetic AVR during the same period and continued warfarin anticoagulation were enrolled as the control group （continuing anticoagulation group）. International normalized ratio （INR） was set between 1.8 and 2.5 during warfarin anticoagulation period in both groups. Survival rate and the incidence of severe adverse events were compared between the 2 groups. Results In the discontinued anticoagulation group,1 patient was lost during follow-up. No thromboembolic event,death or prosthetic valve thrombosis was observed. All the patients were in NYHA class Ⅰ. In the continuinganticoagulation group,3 patients were lost during follow-up. Eleven patients were in NYHA classⅠ and 2 patients were in NYHAclass Ⅱ. Severe anticoagulation-related bleeding events occurred in 3 patients with gastrointestinal bleeding. One patient died of massive outbreak of vomiting blood,and another patient had sudden death. Ten-year survival rate was 100.0% and 86.7% inthe discontinued anticoagulation group and continuing anticoagulation group, respectively. Conclusion For low-risk patientsafter isolated prosthetic AVR,short-term warfarin anticoagulation may be acceptable, which means warfarin is administered only in the first 3 years after surgery and discontinued 3 years after su

关 键 词：主动脉瓣置换 人工机械瓣 抗凝治疗 

分 类 号：R654.2[医药卫生—外科学]