Saksena Devendra, Muralidharan S, Mishra Yugal K, Kanhere Vivek, Mohanty Bipin Bihari, Srivastava C P, Mange Jagdish, Puranik Manish, Nair Manoj P, Goel Pankaj, Srivastava Pankaj, Krishnan R M, Nambala Sathyaki, Raja Vikrama
Professor and Head, Dept. of Cardiac Surgery, Bombay Hospital, Mumbai, Maharashtra.
Chief Cardiothoracic Surgeon, GKNM Hospital, Coimbatore, Tamil Nadu.
J Assoc Physicians India. 2018 Jan;66(1):59-74.
Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. The aim of this review is to assess the role of anticoagulation therapy in the management of valve replacement patients.
Literature from PubMed, Embase, Medline and Google Scholar were searched using the terms "valvular heart disease", "anticoagulant", "mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K antagonist (VKA)", and "acenocoumarol". A committee comprising leading cardiothoracic surgeons from India was convened to review the literature and suggest key practice points.
Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. A paramount risk of thromboembolic events is observed during the first three months after surgery for both mechanical and bioprosthetic devices. The VKA therapy with individualized target international normalized ratio (INR) is recommended in patients after prosthetic valve replacement. Therapies for the management of prosthetic valve complications should be based on the type of complications. Special care is mandated in distinguished individuals and those with various co-morbidities.
In patients with prosthetic valve replacement, anticoagulant therapy with VKA seems to be an effective option. The role for non-VKA oral anticoagulants in the setting of prosthetic valve replacement has yet to be established. Furthermore, whether the novel oral anticoagulants are safe and efficacious in patients after placement of a bioprosthetic valve remains unanswered.
人工瓣膜植入术后需要进行预防性抗凝治疗以预防血栓形成事件。本综述的目的是评估抗凝治疗在瓣膜置换患者管理中的作用。
使用“心脏瓣膜病”“抗凝剂”“机械心脏瓣膜”“生物假体”“桥接”“维生素K拮抗剂（VKA）”和“醋硝香豆素”等术语检索了来自PubMed、Embase、Medline和谷歌学术的文献。召集了一个由印度顶尖心胸外科医生组成的委员会来审查文献并提出关键实践要点。
人工瓣膜植入术后需要进行预防性抗凝治疗以预防血栓形成事件。对于机械瓣膜和生物假体装置，在术后的前三个月观察到血栓栓塞事件的主要风险。对于人工瓣膜置换术后的患者，建议采用具有个体化目标国际标准化比值（INR）的VKA治疗。人工瓣膜并发症的治疗应基于并发症的类型。对于特殊个体和患有各种合并症的患者需要特别护理。
在人工瓣膜置换患者中，VKA抗凝治疗似乎是一种有效的选择。非VKA口服抗凝剂在人工瓣膜置换中的作用尚未确立。此外，新型口服抗凝剂在生物假体瓣膜植入术后患者中是否安全有效仍未得到解答。
