Wei Wei, Dong Taiming, Zheng Zhichao, Huang Shuping
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
J Thorac Dis. 2015 Mar;7(3):288-94. doi: 10.3978/j.issn.2072-1439.2015.01.55.
To evaluate the curative effects and risks of a medical therapy with combined anti-thrombotic agents for thrombosis on prosthetic heart valves.
Twenty-two patients who suffered from thrombosis on prosthetic valves with stable hemodynamics were divided into the inpatient group and the outpatient group. Thrombosis on the valves were demonstrated by transesophageal echocardiographies (TEE). A combined anti-thrombotic therapy with clopidogrel and warfarin were prescribed for all the patients during the whole treatment. Low molecular weight heparin (LMWH) was given twice daily during the first 5 days for the inpatients. The patients accepted regular follow-ups for observation of the functions of prosthetic valves, changes of thrombi, coagulation status and general clinical status.
There were 5 men and 17 women. Thirteen patients suffered from thrombosis on the mechanical mitral valves (MVs), five on the mechanical tricuspid valves (TVs), one on the mechanical aortic valve and tricuspid bio-prosthetic valve, one on the mechanical aortic valve, one on the mitral bio-prosthetic valve, and one on the tricuspid bio-prosthetic valve. After an average of 36.4±23.1 days' observation, 16 (73%) patients' valvular function recovered normal without TTE detectable thrombi, 6 (27%) patients' valvular function remained abnormal including three patients without TTE detectable thrombi during follow-ups. No significant differences of thrombi changes and period of thrombi disappearance were observed between the inpatient group and the outpatient group. For patients with mitral thrombosis, sizes of the left atriums (LAs) decreased an average of 4.1 mm after treatment (95% CI, 1.2-6.9 mm). No significant changes of other chambers and left ventricular ejection fractions (LVEF) were observed. For patients with tricuspid thrombosis, LVEF improved an average of 10.5% after treatment (95% CI, 0.1-17.9%). No significant changes of chambers were observed. None experienced major bleedings except for two cases of mild subcutaneous ecchymoses.
The combined anti-thrombotic therapy based on clopidogrel and warfarin is a feasible treatment for thrombosis on prosthetic heart valves under a close monitoring.
评估联合抗血栓药物治疗人工心脏瓣膜血栓形成的疗效和风险。
将22例人工瓣膜血栓形成且血流动力学稳定的患者分为住院组和门诊组。经食管超声心动图（TEE）证实瓣膜血栓形成。所有患者在整个治疗期间均采用氯吡格雷和华法林联合抗血栓治疗。住院患者在治疗的前5天每天给予两次低分子肝素（LMWH）。患者接受定期随访，观察人工瓣膜功能、血栓变化、凝血状态和一般临床状况。
男性5例，女性17例。13例患者机械二尖瓣（MV）血栓形成，5例机械三尖瓣（TV）血栓形成，1例机械主动脉瓣和三尖瓣生物瓣血栓形成，1例机械主动脉瓣血栓形成，1例二尖瓣生物瓣血栓形成，1例三尖瓣生物瓣血栓形成。平均观察36.4±23.1天后，16例（73%）患者瓣膜功能恢复正常，经胸超声心动图（TTE）未检测到血栓，6例（27%）患者瓣膜功能仍异常，其中3例在随访期间TTE未检测到血栓。住院组和门诊组血栓变化及血栓消失时间无显著差异。二尖瓣血栓形成患者治疗后左心房（LA）大小平均减小4.1mm（95%CI，1.2-6.9mm）。其他腔室和左心室射血分数（LVEF）无显著变化。三尖瓣血栓形成患者治疗后LVEF平均提高10.5%（95%CI，0.1-17.9%）。腔室无显著变化。除2例轻度皮下瘀斑外，无患者发生大出血。
在密切监测下，基于氯吡格雷和华法林的联合抗血栓治疗是人工心脏瓣膜血栓形成的一种可行治疗方法。
