Huda Syed A, Kahlown Sara, Jilani Mohammad H, Chaudhuri Debanik
Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.
Internal Medicine, United Health Services Wilson Medical Center, Johnson City, USA.
Cureus. 2021 Jun 13;13(6):e15619. doi: 10.7759/cureus.15619. eCollection 2021 Jun.
Valvular heart disease is common in the United States, with a number of patients undergoing valve replacement procedures every year. The two types of valve prostheses include mechanical and bioprosthetic valves. Mechanical heart valves require lifelong anticoagulation with vitamin K antagonists like warfarin. The clinicians are often faced with the dilemma of major bleeding episodes such as intracranial hemorrhage or gastrointestinal bleeding in these patients. The management includes reversing warfarin-induced coagulopathy with vitamin K supplementation, fresh frozen plasma, or prothrombin complex concentrate (PCC), with PCC being the treatment of choice. With regard to the safe resumption of anticoagulation, guidelines are silent, and data is limited to case reports/series. This article reviews the present literature for the management of bleeding in patients with mechanical heart valves and the safe duration for holding off anticoagulation with minimal risk of valve thrombosis/thromboembolism.
心脏瓣膜病在美国很常见，每年都有许多患者接受瓣膜置换手术。两种类型的瓣膜假体包括机械瓣膜和生物瓣膜。机械心脏瓣膜需要使用华法林等维生素K拮抗剂进行终身抗凝治疗。临床医生经常面临这些患者发生严重出血事件的困境，如颅内出血或胃肠道出血。治疗措施包括补充维生素K、输注新鲜冰冻血浆或凝血酶原复合物浓缩剂（PCC）来逆转华法林引起的凝血病，其中PCC是首选治疗方法。关于安全恢复抗凝治疗，指南中未提及，数据也仅限于病例报告/系列研究。本文综述了目前关于机械心脏瓣膜患者出血管理以及安全停用抗凝治疗以降低瓣膜血栓形成/血栓栓塞风险的文献。
