Verheugt F W
Department of Cardiology, Heartcenter, University Hospital Nijmegen, The Netherlands.
Thromb Haemost. 1999 Sep;82 Suppl 1:130-5.
Insertion of a mechanical artificial heart valve is an absolute indication for the use of lifelong oral anticoagulation, irrespective the presence or absence of atrial fibrillation. Depending on the type and position of the artificial valve the optimal International Normalized Ratio (INR) for these patients is between 2.5 and 4.5, although more prospective studies on the optimal range of oral anticoagulation are necessary. Addition of low dose antiplatelet therapy may further decrease the rate of thromboembolism, but also here more studies are needed. Patients with a bioprosthesis need only oral anticoagulation for the first three months following surgery in the absence of an indication for anticoagulation for other conditions. Atrial fibrillation is often seen in patients with artificial heart valves. Stroke prevention can be instituted by the mandatory oral anticoagulant therapy. The presence of atrial fibrillation and the use of oral anticoagulation prior to heart valve surgery support the indication for the insertion of a mechanical artificial heart valve. However, relative contraindications to oral anticoagulation and the presence of sinus rhythm may favor the use of a bioprosthesis.
植入机械人工心脏瓣膜是终身口服抗凝治疗的绝对指征，无论是否存在心房颤动。根据人工瓣膜的类型和位置，这些患者的最佳国际标准化比值（INR）在2.5至4.5之间，不过仍需要更多关于口服抗凝最佳范围的前瞻性研究。添加低剂量抗血小板治疗可能会进一步降低血栓栓塞率，但同样也需要更多研究。在没有其他需要抗凝治疗指征的情况下，生物瓣膜患者仅在术后头三个月需要口服抗凝药。人工心脏瓣膜患者常出现心房颤动。可通过强制性口服抗凝治疗来预防中风。心房颤动的存在以及心脏瓣膜手术前口服抗凝药的使用支持植入机械人工心脏瓣膜的指征。然而，口服抗凝的相对禁忌证和窦性心律的存在可能有利于使用生物瓣膜。
