心脏瓣膜置换术后华法林低强度抗凝的随访研究  

Clinical studies of the low-intensity anticoagulation of Warfarin after heart valve replacement

作　　者：王天毅[1] 徐平[1] 高洪波[1] 李贞福[1] 杨苏民[1] 黄强[1] 常青[1] 

机构地区：[1]青岛大学附属医院心血管外科,266000

出　　处：《中华胸心血管外科杂志》2014年第6期356-359,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨心脏瓣膜置换术后应用低强度抗凝的中长期效果，讨论本院现行抗凝标准（主动脉瓣置换1．5—2．0，二尖瓣置换2．0～2．5，主动脉瓣、二尖瓣双瓣置换2．0-2．5，三尖瓣置换2．5-3．0）是否符合本地区心脏瓣膜置换术后临床抗凝要求。方法回顾性分析2009年1月至2011年12月期间就诊本院心外科行瓣膜置换治疗的681例患者临床资料。男307例，女374例；年龄21—81岁，平均（52．37±10．23）岁。患者术后抗凝治疗，记录并分析出血、血栓形成和栓塞等抗凝相关并发症的发生。结果随访患者0．5-43．0个月，完成随访602例，其中出血66例（10．96％），血栓、栓塞11例（1．83％）。结论心脏瓣膜置换术后进行低强度抗凝效果可靠，本院现行抗凝标准符合本地区心脏瓣膜置换术后临床抗凝要求。Objective To investigate the necessity of low-intensity anticoagulation standard in patients after heart valve re- placement and the rationality of INR in our hospital. Methods 681 eligible candidates were anticoagulated under the current guidelines for postoperative anticoagulation therapy in our hospital （ AVR 1.5 - 2.0, MVR 2.0 - 2.5, DVR 2.0 - 2.5, TVR 2.5 - 3.0）. We monitored the patient ＂s PT regularly and analyzed the occurrence of anticoagulation-related complications, such as bleeding, thrombosis and embolism. Results 602 cases completed the follow-up. During the period of fo]low-up, 66 patients had bleeding tendencies, the incidence of bleeding complications was 10.96% （66/602）. 11 patients had embolism complications, the incidence of thrombotic complications was 1.83 % （11/602）. The average of INR was 2.24± 0.68, the mean oral Warfarin dose was（3.12± 1.14 ） mg/d. Conclusion Our study suggest that the effect of low-intensity anticoagulation after heart valve replacement is reliable. Further more, the current anticoagulation standards of our hospital meet the requirements of postoperative clinical anticoagulant after heart valve replacement in our region.

关 键 词：心脏瓣膜假体植入 华法林 抗凝强度 

分 类 号：R654.2[医药卫生—外科学]