华法林治疗不会增加心脏移植患者的出血风险。

Warfarin therapy does not increase bleeding in patients undergoing heart transplantation.

作者信息

Morris C D, Vega J D, Levy J H, Buist N N, Smith A L, Despotis G J, Kanter K R

机构信息

Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.

出版信息

Ann Thorac Surg. 2001 Sep;72(3):714-8. doi: 10.1016/s0003-4975(01)02828-4.

DOI:10.1016/s0003-4975(01)02828-4

PMID:11565646

Abstract

BACKGROUND

Historically, warfarin has been discontinued or rapidly reversed with fresh frozen plasma in patients awaiting heart transplantation because of concerns regarding excessive bleeding. Because preoperative warfarin may have effects on bleeding after cardiac operations, we reviewed our experience to determine the risks in patients undergoing heart transplantation while maintained on warfarin.

METHODS

The records of consecutive adult patients undergoing heart transplantation from January 1996 to December 1998 were reviewed. Preoperative and 24-hour postoperative data were obtained, including patient demographics; hematologic laboratory values; medication use; repeat or primary sternotomy data; allogeneic blood product administration; and chest tube drainage. Multivariate linear and logistic regression analyses were performed using these variables to determine risk factors for bleeding after heart transplantation.

RESULTS

Ninety adult patients, mean age 50 years, underwent orthotopic heart transplantation during the 36-month period. No relationships existed between preoperative international normalized ratio (INR, mean = 1.83 +/- 0.1, p = 0.84) or postoperative INR (mean = 2.2 +/- 0.9, p = 0.63) and chest tube drainage (mean = 721 +/- 63 mL). Relationships were observed between total blood product administration and preoperative INR (partial r = 0.30, p = 0.01) and postoperative INR (partial r = -0.37, p = 0.002); however, preoperative INR did not correlate (p = 0.29) when perioperative use of fresh frozen plasma was factored as a covariate. Inverse relationships were evident between postoperative INR and total blood product exposures, as well as transfusions of platelets (partial r = -0.26, p = 0.03), fresh frozen plasma (partial r = -0.28, p = 0.02), and red cells (partial r = -0.25, p = 0.04).

CONCLUSIONS

Although we noted no correlations between INR and chest tube output, inverse relationships were observed with transfusion requirements in the first 24 hours after transplantation. Preoperative warfarin may be safely continued in patients awaiting heart transplantation.

摘要

背景

以往，由于担心出血过多，在等待心脏移植的患者中，华法林已被停用或用新鲜冰冻血浆迅速逆转。由于术前华法林可能对心脏手术后的出血有影响，我们回顾了我们的经验，以确定在服用华法林的情况下接受心脏移植患者的风险。

方法

回顾了1996年1月至1998年12月连续接受心脏移植的成年患者的记录。获取术前和术后24小时的数据，包括患者人口统计学资料；血液学实验室值；药物使用情况；再次或初次胸骨切开术数据；同种异体血液制品的使用；以及胸管引流情况。使用这些变量进行多因素线性和逻辑回归分析，以确定心脏移植后出血的危险因素。

结果

在36个月期间，90例成年患者（平均年龄50岁）接受了原位心脏移植。术前国际标准化比值（INR，平均值=1.83±0.1，p=0.84）或术后INR（平均值=2.2±0.9，p=0.63）与胸管引流量（平均值=721±63mL）之间无相关性。观察到全血制品使用总量与术前INR（偏相关系数r=0.30，p=0.01）和术后INR（偏相关系数r=-0.37，p=0.002）之间存在相关性；然而，当将围手术期新鲜冰冻血浆的使用作为协变量时，术前INR无相关性（p=0.29）。术后INR与全血制品暴露总量以及血小板输注量（偏相关系数r=-0.26，p=0.03）、新鲜冰冻血浆输注量（偏相关系数r=-0.28，p=0.02）和红细胞输注量（偏相关系数r=-0.25，p=0.04）之间存在明显的负相关关系。