Liu Yuan, Yu Xi-yong, Zhong Shi-long, Yang Min, Tan Hong-hong, Fei Hong-wen, Chen Ji-yan
Department of Cardiology, Medical Research Center, Guangdong Cardiovascular Institute, People's Hospital of Guangdong Province, Guangzhou 510081, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 Oct;30(10):2242-5.
To investigate the clinical application of anticoagulation treatment with warfarin after prosthetic heart valve replacement and compare the effect and safety of different anticoagulant intensities.
A total of 845 Chinese patients receiving oral warfarin for anticoagulant treatment after prosthetic heart valve replacement in Guangdong General Hospital between 2000 and 2008 were enrolled in this survey. The general data, clinical data, medications, international normalized ratio (INR) and results of echocardiogram of these patients were followed up to observe the incidence of complication of thrombo-embolism and such adverse effect as hemorrhage.
All the patients were of Han nationality, and Cantonese accounted for 88.04%. The daily mean maintenance dose of warfarin was 2.92∓0.88 mg in these patients with a median INR of 2.09∓0.39. Of these patients, 44.62% received low-intensity anticoagulant treatment with warfarin with the INR maintained between 1.5 and 2.0, and 56.45% had standard anticoagulant intensity with the INR maintained between 2.0 and 3.0. The total incidence of thrombo-embolism was 4.14%. Severe hemorrhage occurred in 14 cases (1.66%), most frequently in the alimentary tract. The events of hemorrhage were correlated to the type of prosthetic heart valve replacement, occurring more frequently in patients with mechanical prosthetic heart valve replacement than in those with biological ones. No significant difference was found in the incidence of thrombo-embolism and server hemorrhage between the two groups receiving low and standard intensity therapy anticoagulant.
The effect and safety of low-intensity anticoagulant treatment are comparable to that of standard intensity treatment in Chinese Han patients, and anticoagulation treatment with warfarin is effective and safe to maintain the INR between 1.8-3.0.
探讨华法林抗凝治疗在人工心脏瓣膜置换术后的临床应用，并比较不同抗凝强度的效果及安全性。
选取2000年至2008年期间在广东省人民医院接受人工心脏瓣膜置换术后口服华法林抗凝治疗的845例中国患者进行调查。对这些患者的一般资料、临床资料、用药情况、国际标准化比值（INR）及超声心动图结果进行随访，观察血栓栓塞并发症的发生率及出血等不良反应。
所有患者均为汉族，其中粤语使用者占88.04%。这些患者华法林的每日平均维持剂量为2.92±0.88mg，INR中位数为2.09±0.39。其中，44.62%的患者接受华法林低强度抗凝治疗，INR维持在1.5至2.0之间；56.45%的患者采用标准抗凝强度，INR维持在2.0至3.0之间。血栓栓塞的总发生率为4.14%。14例（1.66%）发生严重出血，最常见于消化道。出血事件与人工心脏瓣膜置换类型相关，机械瓣置换患者的出血发生率高于生物瓣置换患者。低强度和标准强度抗凝治疗组之间的血栓栓塞和严重出血发生率无显著差异。
在中国汉族患者中，低强度抗凝治疗的效果和安全性与标准强度治疗相当，华法林抗凝治疗将INR维持在1.8 - 3.0之间是有效且安全的。
