CAJ | 학술논문

心脏机械瓣膜置换术后由于异物的置入，激活了内源性及外源性凝血机制，容易在人造瓣膜周围形成血栓，临床上常规使用华法林抗凝治疗。但在术后早期（<1个月，尤其是术后0～5天）由于华法林抗凝起效慢，更易形成血栓。有观点认为，术后在华法林起效前，加用低分子肝素联合华法林治疗对确保远期疗效具有重要的意义。但另有观点认为，在术后早期由于体外循环、心脏手术的影响，患者凝血、抗凝、纤溶及血小板等系统尚不稳定，患者处于低凝状态，加用低分子肝素过渡抗凝会增加患者出血的风险。本文总结国内外相关文献，阐述低分子肝素在心脏机械瓣膜置换术后早期过渡抗凝治疗中的应用。
심장궤계판막치환술후유우이물적치입，격활료내원성급외원성응혈궤제，용역재인조판막주위형성혈전，림상상상규사용화법림항응치료。단재술후조기（<1개월，우기시술후0～5천）유우화법림항응기효만，경역형성혈전。유관점인위，술후재화법림기효전，가용저분자간소연합화법림치료대학보원기료효구유중요적의의。단령유관점인위，재술후조기유우체외순배、심장수술적영향，환자응혈、항응、섬용급혈소판등계통상불은정，환자처우저응상태，가용저분자간소과도항응회증가환자출혈적풍험。본문총결국내외상관문헌，천술저분자간소재심장궤계판막치환술후조기과도항응치료중적응용。
The placement of a foreign body after mechanical heart valve replacement activates the en-dogenous and exogenous coagulation mechanism. And it is easy to form thromboembolism around the artifi-cial valve. Routinely we use anticoagulation therapy with warfarin in clinic. But early after mechanical valve replacement (<1 month, especially in 0~5 d after the surgery), because the anticoagulation effect of warfarin delays, it is more easy to form thromboembolism. Therefore, there exists an opinion that before warfarin reaches the effective anticoagulation, the therapy of low molecular weight heparin combining with warfarin has an important significance to ensure the forward effect after mechanical valve replacement. But the others insist that in early period after surgery, because of the influence of extracorporeal circulation and cardiac surgery, the body is generally in a low condensate state for the disordered function of systems such as blood coagulation, fibrinolysis, platelet, etc, bridging therapy may increase the risk of bleeding. This paper illustrates the use of low molecular weight heparin for bridging therapy in early period after mechanical heart valve replacement surgery.