Panduranga Prashanth, Al-Mukhaini Mohammed, Al-Muslahi Muhanna, Haque Mohammed A, Shehab Abdullah
Prashanth Panduranga, Mohammed Al-Mukhaini, Department of Cardiology, Royal Hospital, PB 1331, Muscat-111, Oman.
World J Cardiol. 2012 Mar 26;4(3):54-9. doi: 10.4330/wjc.v4.i3.54.
Management of warfarin-induced major bleeding in patients with mechanical heart valves is challenging. There is vast controversy and confusion in the type of treatment required to reverse anticoagulation and stop bleeding as well as the ideal time to restart warfarin therapy safely without recurrence of bleeding and/or thromboembolism. Presently, the treatments available to reverse warfarin-induced bleeding are vitamin K, fresh frozen plasma, prothrombin complex concentrates and recombinant activated factor VIIa. Currently, vitamin K and fresh frozen plasma are the recommended treatments in patients with mechanical heart valves and warfarin-induced major bleeding. The safe use of prothrombin complex concentrates and recombinant activated factor VIIa in patients with mechanical heart valves is controversial and needs well-designed clinical studies. With regard to restarting anticoagulation in patients with warfarin-induced major bleeding and mechanical heart valves, the safe period varies from 7-14 d after the onset of bleeding for patients with intracranial bleed and 48-72 h for patients with extra-cranial bleed. In this review article, we present relevant literature about these controversies and suggest recommendations for management of patients with warfarin-induced bleeding and a mechanical heart valve. Furthermore, there is an urgent need for separate specific guidelines from major associations/ professional societies with regard to mechanical heart valves and warfarin-induced bleeding.
机械心脏瓣膜患者华法林所致严重出血的管理颇具挑战性。在逆转抗凝及止血所需的治疗类型以及安全重启华法林治疗且不发生出血和/或血栓栓塞复发的理想时机方面，存在广泛的争议和困惑。目前，可用于逆转华法林所致出血的治疗方法有维生素K、新鲜冰冻血浆、凝血酶原复合物浓缩剂和重组活化因子VIIa。当前，维生素K和新鲜冰冻血浆是机械心脏瓣膜患者及华法林所致严重出血的推荐治疗方法。凝血酶原复合物浓缩剂和重组活化因子VIIa在机械心脏瓣膜患者中的安全使用存在争议，需要精心设计的临床研究。关于华法林所致严重出血且有机械心脏瓣膜的患者重启抗凝，颅内出血患者出血发作后7 - 14天为安全期，颅外出血患者为48 - 72小时。在这篇综述文章中，我们呈现了有关这些争议的相关文献，并针对华法林所致出血且有机械心脏瓣膜的患者的管理提出建议。此外，各大协会/专业学会迫切需要制定关于机械心脏瓣膜和华法林所致出血的单独特定指南。
