邬晓臣, 岳琴, 王舰, 欧阳辉, 丁盛, 辛梅, 石国芹, 张近宝. 亚治疗剂量低分子肝素作为机械瓣膜患者再次外科手术的桥接抗凝治疗效果[J]. 心脏杂志, 2019, 31(4): 438-441. DOI: 10.12125/j.chj.201810063
    引用本文: 邬晓臣, 岳琴, 王舰, 欧阳辉, 丁盛, 辛梅, 石国芹, 张近宝. 亚治疗剂量低分子肝素作为机械瓣膜患者再次外科手术的桥接抗凝治疗效果[J]. 心脏杂志, 2019, 31(4): 438-441. DOI: 10.12125/j.chj.201810063
    Xiao-chen WU, Qin YUE, Jian WANG, Hui OUYANG, Sheng DING, Mei XIN, Guo-qin SHI, Jin-bao ZHANG. Subtherapeutic low-molecular-weight heparin as a bridge anticoagulation therapy for patients undergoing mechanical valve replacement surgery[J]. Chinese Heart Journal, 2019, 31(4): 438-441. DOI: 10.12125/j.chj.201810063
    Citation: Xiao-chen WU, Qin YUE, Jian WANG, Hui OUYANG, Sheng DING, Mei XIN, Guo-qin SHI, Jin-bao ZHANG. Subtherapeutic low-molecular-weight heparin as a bridge anticoagulation therapy for patients undergoing mechanical valve replacement surgery[J]. Chinese Heart Journal, 2019, 31(4): 438-441. DOI: 10.12125/j.chj.201810063

    亚治疗剂量低分子肝素作为机械瓣膜患者再次外科手术的桥接抗凝治疗效果

    Subtherapeutic low-molecular-weight heparin as a bridge anticoagulation therapy for patients undergoing mechanical valve replacement surgery

    • 摘要:
        目的  机械心脏瓣膜(MHV)患者接受再次手术时,需要中断华法林的抗凝治疗,往往需要桥接低分子肝素(LMWH)进行抗凝。本研究的目的是评估MHV患者再次接受择期手术(心脏手术和非心脏手术)桥接亚治疗剂量的LMWH是否是一种安全有效的方法。
        方法  观察我院在2013年1月1日到2018年1月1日收治的需再次择期手术的机械瓣膜置换术后患者(瓣膜置换组,n = 47),瓣膜置换组纳入标准是围手术期桥接抗凝的机械瓣置换的患者,并经心外科医生制定桥接抗凝方案患者(机械瓣主动脉瓣置换术后患者14例,机械瓣二尖瓣/双瓣置换术后患者33例),以同期行相同手术的患者(未做过瓣膜置换术)为对照组(n = 47),主要观察指标是住院病死率、术中出血量、桥接后30 d内血栓栓塞事件或主要出血事件的发生率。
        结果  瓣膜置换组术中出血量及术后第一个24 h出血量较对照显著增多(P < 0.05),瓣膜置换组1例死亡(2%),死亡原因为低心排,并出现1例(2%)出血事件,两组均未发生栓塞事件,但与对照组相比两组病死率、栓塞事件和出血事件发生率均无显著性差异。
        结论  机械瓣膜置换术后患者在进行择期外科手术期间采用亚治疗剂量LMWH进行桥接抗凝术中出血量增多,但严重并发症发生率无显著增加,此结论尚需进一步验证。

       

      Abstract:
        AIM   Patients with mechanical heart valves (MHV) need to discontinue anticoagulation therapy with coumadin during reoperation, and often require bridging with low molecular weight heparin (LMWH) for anticoagulation. The aim of this study was to assess whether subtherapeutic doses of LMWH at bridged anticoagulation (cardiac and non-cardiac) in MHV patients is a safe and effective method.
        METHODS  The patients with mechanical valve replacement who needed reoperation in our hospital from January 1, 2013 to January 1, 2018 were observed and compared with the patients who underwent the same operation at the same time. The valve replacement group, of which the bridging anticoagulation scheme were decided by cardiac surgeons, consisted of 14 cases after aortic mechanical valve replacemen and 33 cases after aortic and metric mechanical valve replacement. The main outcome measures were hospital mortality, intraoperative bleeding, thromboembolism (TE) events or major bleeding (MBE) events within 30 days after bridging anticoagulation.
        RESULTS  During the study period, 47 patients received subtherapeutic doses of LMWH bridging anticoagulation therapy. Compared with the same operation at the same time, there was no significant difference in intraoperative and postoperative bleeding volume. The bleeding volume at the first 24 hours after operation in valve replacement group was significantly different from control group (P < 0.05). There was no TE event in the mechanical mitral valve replacement group and one death in valve replacement group (0.4%). The cause of death was low cardiac output. There was no perioperative death in control groups. One case (3.3%) of hemorrhage occurred in valve replacement group during the study period (within 30 days of bridging anticoagulation). There was no significant difference between the two groups.
        CONCLUSION  Bridging anticoagulation with sub-therapeutic doses of low molecular weight heparin may increase the intropaerative bleeding but not severe complications like TE and MBE which need additional larger studies.

       

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