CAJ | 학술논문

目的通过对心脏瓣膜置换术后华法林抗凝治疗的分析,探讨华法林最适抗凝强度.方法回顾性分析265例心脏瓣膜置换术后患者华法林抗凝治疗、给药方法及国际标准化比值(INR)监测情况.根据瓣膜置换位置的不同,分为主动脉瓣置换术(AVR)组(37例)、二尖瓣置换术(MVR)组(165例)、双瓣膜置换术(DVR)组(63例),各组再按照不同的抗凝强度,分为INR 1.5～2.0、INR 2.1～ 2.5共2个亚组,对比分析出血及血栓栓塞发生情况.结果随访患者265例,随访时间4个月至6年.华法林剂量0.625 ～ 7.500(2.5±1.4) mg/d,发生抗凝不良事件23例,其中出血18例(6.79％,18/265),明显高于血栓栓塞5例(1.89％,5/265),差异有统计学意义(P＜0.05).4例出现偏瘫后遗症,死亡2例.AVR组、MVR组、DVR组患者INR 1.5 ～ 2.0出血发生率比INR 2.1 ～ 2.5明显降低[0(0/20)比1/17、3.57％(3/84)比11.11％(9/81)、2.70％ (1/37)比15.38％(4/26)],且差异有统计学意义(P＜0.05);AVR组、MVR组、DVR组患者INR 1.5 ～ 2.0、2.1～2.5血栓栓塞发生率比较差异均无统计学意义(P＞0.05).结论心脏瓣膜置换术后华法林抗凝过程中,宜选择INR 1.5 ～ 2.0低强度抗凝治疗,AVR的INR控制在1.5 ～ 1.8,MVR或DVR的INR控制在1.8～ 2.0,根据不同病情,制定个体化抗凝治疗方案.
목적 통과대심장판막치환술후화법림항응치료적분석,탐토화법림최괄항응강도.방법 회고성분석265례심장판막치환술후환자화법림항응치료、급약방법급국제표준화비치(INR)감측정황.근거판막치환위치적불동,분위주동맥판치환술(AVR)조(37례)、이첨판치환술(MVR)조(165례)、쌍판막치환술(DVR)조(63례),각조재안조불동적항응강도,분위INR 1.5～2.0、INR 2.1～ 2.5공2개아조,대비분석출혈급혈전전새발생정황.결과 수방환자265례,수방시간4개월지6년.화법림제량0.625 ～ 7.500(2.5±1.4) mg/d,발생항응불량사건23례,기중출혈18례(6.79％,18/265),명현고우혈전전새5례(1.89％,5/265),차이유통계학의의(P＜0.05).4례출현편탄후유증,사망2례.AVR조、MVR조、DVR조환자INR 1.5 ～ 2.0출혈발생솔비INR 2.1 ～ 2.5명현강저[0(0/20)비1/17、3.57％(3/84)비11.11％(9/81)、2.70％ (1/37)비15.38％(4/26)],차차이유통계학의의(P＜0.05);AVR조、MVR조、DVR조환자INR 1.5 ～ 2.0、2.1～2.5혈전전새발생솔비교차이균무통계학의의(P＞0.05).결론 심장판막치환술후화법림항응과정중,의선택INR 1.5 ～ 2.0저강도항응치료,AVR적INR공제재1.5 ～ 1.8,MVR혹DVR적INR공제재1.8～ 2.0,근거불동병정,제정개체화항응치료방안.
Objective To analyze warfarin anticoagulation therapy for patients after heart valve replacement,and to explore an optimal intensity of warfarin anticoagulation.Methods The administration method,international normalized ratio (INR) monitoring of 265 patients who received warfarin anticoagulation therapy after heart valve replacement were analyzed retrospectively.The patients were divided into three groups according to different valve prostheses:aortic valve replacement (AVR) group (37 cases),mitral valve replacement (MVR) group (165 cases) and double valve replacement (DVR) group (63 cases).Each group was divided into two subgroups according to their INR levels (INR 1.5-2.0,INR 2.1-2.5).The occurrence of bleeding and thromboembolic events in these subgroups were compared.Results A total of 265 cases were visited,and followed up for 4 months to 6 years.The dose of warfarin was 0.625-7.500 (2.5 ± 1.4) mg/d.The incidence of anticoagulation adverse events was 23 cases.The incidence of bleeding events was 6.79％ (18/265),which was higher than that of thromboembolic events (1.89％,5/265),and there was significant difference (P ＜ 0.05).Four cases of the hemiplegia sequelae occurred and 2 cases died.The incidence of bleeing events in patients with INR1.5-2.0 in AVR group,MVR group and DVR group were 0 (0/20),3.57％ (3/84),2.70％ (1/37),in patients with INR 2.1-2.5 were 1/17,11.11％ (9/81),15.38％ (4/26),and there were significant differences (P ＜ 0.05).There were no significant differences in the incidence of thromboembolic events between INR 1.5-2.0 and INR 2.1-2.5 in AVR group,MVR group and DVR group (P ＞ 0.05).Conclusions After heart valve replacement,the anticoagulation therapy with warfarin is effective and safe to maintain the low intensity anticoagulation (INR1.5-2.0).AVR and MVR/DVR may benefit from a treatment strategy with levels ranging from 1.5-1.8 and 1.8-2.0,and the anticoagulation therapy of individuation should be formulated according to different conditions.