Gohlke-Bärwolf C
Herz-Zentrum Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany,
Z Kardiol. 2001 Dec;90(Suppl 6):112-7. doi: 10.1007/s003920170018.
Within the last few years, marked progress has been made in the prevention of thromboembolic events in patients with mechanical heart valves. Thus, therapy has become more effective and is associated with less risk. This includes a number of developments like the introduction of the internationalized, normalized ratio (INR) for determination of the intensity of anticoagulation, the concept of a risk factor-adjusted, prosthesis specific, individualized indication for and intensity of anticoagulation and the possibility for self-determination of anticoagulation intensity by the patient. Prospective, randomized studies on the effect of different intensities of anticoagulation allowed definitions of individualized anticoagulation target levels and were the basis for guidelines on clinical management of anticoagulation. In spite of this progress, thromboembolic complications and anticoagulation associated bleedings are still the most frequent complications after valve replacement. The guidelines published by the professional societies on anticoagulation should be followed more closely in daily clinical practice. The management of oral anticoagulant treatment can be improved by following the concept of a risk factor-adjusted indication for and intensity of oral anticoagulant treatment as well as the use of the INR for monitoring the intensity of anticoagulation. Intensive education of the patient, implementation of self-testing by suitable patients and increasing the frequency of testing can further contribute to improvement.
在过去几年中，机械心脏瓣膜患者血栓栓塞事件的预防取得了显著进展。因此，治疗变得更加有效且风险更低。这包括多项进展，如引入国际标准化比值（INR）来确定抗凝强度、根据风险因素调整的、针对假体的、个体化的抗凝指征和强度的概念，以及患者自我确定抗凝强度的可能性。关于不同抗凝强度效果的前瞻性随机研究确定了个体化抗凝目标水平，并成为抗凝临床管理指南的基础。尽管取得了这些进展，但血栓栓塞并发症和抗凝相关出血仍是瓣膜置换术后最常见的并发症。专业学会发布的抗凝指南在日常临床实践中应得到更严格的遵循。遵循根据风险因素调整的口服抗凝治疗指征和强度的概念，以及使用INR监测抗凝强度，可以改善口服抗凝治疗的管理。对患者进行强化教育、让合适的患者进行自我检测并增加检测频率，可进一步有助于改善治疗效果。
