Vahanian Alec
Hôpital Bichat, Paris, France.
Herz. 2008 Feb;33(1):44-51. doi: 10.1007/s00059-008-3079-3.
To avoid the devastating consequences of thromboembolism and bleeding in patients with valve disease, in particular those with prosthetic valves, it is of utmost importance to correctly manage anticoagulation.Patients with mitral stenosis and either permanent or paroxysmal atrial fibrillation should receive anticoagulation, whereas those in sinus rhythm should only receive it in selected cases. In patients with prosthetic valves, anticoagulation management should be governed by the risk-benefit ratio taking factors related both to the patient and the prosthesis into account. Aspirin should be added only when there is a specific indication, such as concomitant arterial disease or embolism. In the future, improvements will be the result of the development of less thrombogenic valve substitutes, increased performance of conservative procedures, development of new antithrombotic agents, and, finally, increased use of self-assessment by better-educated patients.
为避免瓣膜病患者，尤其是人工瓣膜患者发生血栓栓塞和出血的灾难性后果，正确管理抗凝治疗至关重要。二尖瓣狭窄且伴有永久性或阵发性心房颤动的患者应接受抗凝治疗，而窦性心律患者仅在特定情况下接受抗凝治疗。对于人工瓣膜患者，抗凝管理应综合考虑与患者和假体相关的因素，权衡风险与获益。仅在有特定指征时，如合并动脉疾病或栓塞，才应加用阿司匹林。未来，血栓形成性更低的瓣膜替代品的研发、保守手术操作的改进、新型抗血栓药物的研发，以及最后，受教育程度更高的患者自我评估的更多应用，将带来改善。
