Department of Oncology, Badalona-Applied Research Group in Oncology: B-ARGO Group, Catalan Institute of Oncology, Universitat Autònoma de Barcelona, Badalona, Spain.
Department of Cardiovascular Surgery, Hospital Germans Trias i Pujol, Badalona, Spain.
J Thromb Thrombolysis. 2019 Apr;47(3):454-461. doi: 10.1007/s11239-018-1790-3.
Mechanical heart valves (MHV) require life-long anticoagulation with vitamin K antagonists (VKA), but anticoagulation management is complex in patients with cancer due to a high risk of thrombosis and bleeding. This is a retrospective, single-center study to assess anticoagulation management and thrombotic (stroke/valve thrombosis) and bleeding events in patients with active cancer and MHV. The incidence of thrombotic complications was compared to a control group (matched 1:1) of patients with MHV but without cancer. We included 48 patients, 60% of whom had aortic prostheses, 23% mitral prostheses and 17% both types. All patients received VKA as anticoagulant. With a median follow-up of 5.12 years, we observed two arterial thrombotic events (two strokes and no heart valve thrombosis). The 5-year incidence (95% confidence interval [CI]) of stroke/valve thrombosis was 5.7% (0.9-17.9%). The control group had a similar incidence of stroke/valve thrombosis (5-year incidence 7.9% [95%CI 2-19.8], p = 0.16). There were also 15 major bleeding episodes in the cancer group, 11 of which were related to a surgical procedure. The 5-year incidence (95% CI) of major bleeding was 32.9% (18.5-48%), and that of major bleeding unrelated to any procedure was 10.3% (3-23%). We found a low incidence of thrombotic events in this series of patients with active cancer and MHV who were anticoagulated with VKA. However, the incidence of bleeding was high, particularly in relation to invasive procedures.
机械心脏瓣膜 (MHV) 需要终身使用维生素 K 拮抗剂 (VKA) 进行抗凝治疗，但由于血栓形成和出血的风险较高，癌症患者的抗凝管理较为复杂。这是一项回顾性、单中心研究，旨在评估患有活动性癌症和 MHV 的患者的抗凝管理以及血栓形成（中风/瓣膜血栓形成）和出血事件。将血栓并发症的发生率与患有 MHV 但无癌症的对照组（1:1 匹配）进行比较。我们纳入了 48 名患者，其中 60%患有主动脉假体，23%患有二尖瓣假体，17%两种假体都有。所有患者均接受 VKA 抗凝治疗。中位随访 5.12 年后，我们观察到 2 例动脉血栓形成事件（2 例中风，无心脏瓣膜血栓形成）。中风/瓣膜血栓形成的 5 年发生率（95%置信区间 [CI]）为 5.7%（0.9-17.9%）。对照组的中风/瓣膜血栓形成发生率相似（5 年发生率为 7.9% [95%CI 2-19.8%]，p=0.16）。癌症组还发生了 15 次重大出血事件，其中 11 次与手术有关。重大出血的 5 年发生率（95%CI）为 32.9%（18.5-48%），与任何手术无关的重大出血发生率为 10.3%（3-23%）。我们发现，在接受 VKA 抗凝治疗的活动性癌症和 MHV 患者中，血栓形成事件的发生率较低。然而，出血发生率较高，尤其是与侵入性手术有关。
