Liang Yan, Yang Guiying, Li Hong, Ding Ning, Zhang Lin, Chen Jian
Department of Public Health, Chengdu Medical College, 783 Xindu Avenue, Xindu District, Chengdu, 610599, Sichuan Province, China.
Department of Anesthesiology, The Second Affiliated Hospital of the Army Medical University, 83 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
Heliyon. 2023 Jun 8;9(6):e16858. doi: 10.1016/j.heliyon.2023.e16858. eCollection 2023 Jun.
To clarify the timing of warfarin discontinuation at different ranges of INR. Improve anticoagulation management in non-cardiac surgical patients with MHV.
This is a single-center retrospective observational study.
and participants This study used data from the Hospital Information System, and the Surgery and Anesthesia Information System of the Second Affiliated Hospital of Army Military Medical University. Participants included 121 adult patients with MHV who underwent non-cardiac surgery from 2012 to 2021.
, 121 patients with MHV (15 aortic valve only, 56 mitral valve only, and 50 with multiple valves) underwent non-cardiac surgery. When the duration of warfarin discontinuation was ≤ 3 days, 3-5 days, and≥5 days, the INR was 1.45, 1.15, and 1.09, respectively. Bleeding between INR ≤1.2 and INR >1.2 groups was not statistically significant using Student's t-test (95% CI -0.57, 0.14 P = 0.24). Multivariate regression analysis revealed that Intraoperative bleeding volume correlated with preoperative albumin levels (OR = 0.68，95% CI 0.49, 0.89).
When need preoperative INR is less than 1.5 in patients with MHV undergoing non-cardiac surgery, preoperative warfarin discontinuation for 3 days is sufficient. If INR less than 1.2, preoperative warfarin discontinuation for 3-5 days is appropriate. And in patients with MHV underwent abdominal surgery, intraoperative bleeding is not significant reduced by lower INR after preoperative warfarin discontinuation. Furthermore, the effect of albumin levels on coagulation function cannot be ignored in patients with MHV.
This study was derived from real-world clinical data. It's a retrospectively study to describe the INR changed according to the duration of warfarin discontinuation in patients with MHV and compared intraoperation of bleeding volume between INR>1.2 and INR ≤ 1.2after warfarin discontinuation. To clarify the timing of warfarin discontinuation at different ranges of INR. Improve anticoagulation management in non-cardiac surgical patients with MHV, while providing clinicians with a reference for preoperative warfarin adjustment. This study does have a few limitations. The number of cases is small because patients undergoing repeat noncardiac surgery after heart valve surgery are a special case population. And the patients were not followed up after non-cardiac surgery. The impact of changes in INR on postoperative complications could not be assessed in patients with MHV.
明确在不同国际标准化比值（INR）范围内停用华法林的时机。改善二尖瓣狭窄（MHV）非心脏手术患者的抗凝管理。
这是一项单中心回顾性观察研究。
本研究使用了陆军军医大学第二附属医院医院信息系统、手术和麻醉信息系统的数据。参与者包括2012年至2021年期间接受非心脏手术的121例成年MHV患者。
121例MHV患者（仅主动脉瓣15例，仅二尖瓣56例，多瓣膜50例）接受了非心脏手术。当华法林停药时间≤3天、3 - 5天和≥5天时，INR分别为1.45、1.15和1.09。使用学生t检验，INR≤1.2组和INR>1.2组之间的出血情况无统计学意义（95%可信区间 - 0.57，0.14；P = 0.24）。多因素回归分析显示，术中出血量与术前白蛋白水平相关（比值比=0.68，95%可信区间0.49，0.89）。
MHV患者非心脏手术术前INR小于1.5时，术前停用华法林3天就足够了。如果INR小于1.2，术前停用华法林3 - 5天是合适的。并且对于接受腹部手术的MHV患者，术前停用华法林后降低INR并不能显著减少术中出血。此外，白蛋白水平对MHV患者凝血功能的影响不可忽视。
本研究来源于真实世界临床数据。这是一项回顾性研究，描述了MHV患者华法林停药时间与INR变化的关系，并比较了华法林停药后INR>1.2和INR≤1.2患者的术中出血量。以明确不同INR范围内华法林停药的时机。改善MHV非心脏手术患者的抗凝管理，同时为临床医生术前调整华法林提供参考。本研究确实有一些局限性。病例数量较少，因为心脏瓣膜手术后接受重复非心脏手术的患者是一个特殊病例群体。并且非心脏手术后未对患者进行随访。无法评估MHV患者INR变化对术后并发症的影响。
