Verrier E D, Tranbaugh R F, Soifer S J, Yee E S, Turley K, Ebert P A
J Thorac Cardiovasc Surg. 1986 Dec;92(6):1013-20.
The optimal method of anticoagulation in children with mechanical heart valves is controversial. Between 1975 and 1986, aspirin or aspirin with dipyridamole has been used for anticoagulation in children receiving a mechanical aortic valve at the University of California, San Francisco. Fifty-one patients (ages 1 to 23 years, mean 12.9 years) were treated with aspirin (n = 45) or aspirin with dipyridamole (n = 6) and observed a mean of 36.5 months (range 3 to 100 months). There were four late deaths: two from endocarditis and two from other medical problems, but none related to thrombosis or embolus. Follow-up was accomplished by direct contact with the patient, parent, or referring physician. Two patients (3.9%) were lost to late follow-up. One minor neurologic event occurred perioperatively and resolved spontaneously. There were no postoperative thromboembolic events. Eleven asymptomatic children were recently studied by magnetic resonance imaging or computed axial tomography of the brain and had no evidence of prior silent cerebral thromboembolic defects. There were four patients (5.9%) who had minor hemorrhagic complications: Three patients had nosebleeds and one patient had an upper gastrointestinal hemorrhage. Five patients were changed to warfarin anticoagulation: the patient with upper gastrointestinal hemorrhage and four older patients because of physician preference, all after uncomplicated aspirin therapy. There were no mechanical valve failures, although one patient required reoperation 9 months later for perivalvular leak. All children have remained in normal sinus or paced rhythm during follow-up. These results show that children with mechanical aortic valves in normal sinus rhythm can be safely treated with aspirin (or aspirin with dipyridamole) with little risk of thromboembolic events, valve thrombosis, or valve failure. Hemorrhagic complications resulting from aspirin are minor and easily treated.
对于患有机械心脏瓣膜的儿童，最佳抗凝方法存在争议。1975年至1986年间，加利福尼亚大学旧金山分校对接受机械主动脉瓣置换术的儿童使用阿司匹林或阿司匹林联合双嘧达莫进行抗凝治疗。51例患者（年龄1至23岁，平均12.9岁）接受了阿司匹林治疗（n = 45）或阿司匹林联合双嘧达莫治疗（n = 6），平均观察时间为36.5个月（范围3至100个月）。有4例晚期死亡：2例死于心内膜炎，2例死于其他医疗问题，但均与血栓形成或栓塞无关。通过直接与患者、家长或转诊医生联系进行随访。2例患者（3.9%）失访。围手术期发生1例轻度神经系统事件，随后自发缓解。术后无血栓栓塞事件发生。最近对11例无症状儿童进行了脑部磁共振成像或计算机断层扫描，未发现既往无症状脑栓塞缺陷的证据。有4例患者（5.9%）出现轻度出血并发症：3例患者鼻出血，1例患者上消化道出血。5例患者改为华法林抗凝：上消化道出血患者1例，4例年龄较大患者因医生偏好而更改，均在阿司匹林治疗无并发症后进行。尽管有1例患者9个月后因瓣周漏需要再次手术，但未发生机械瓣膜故障。随访期间所有儿童均维持正常窦性心律或起搏心律。这些结果表明，窦性心律正常的机械主动脉瓣儿童使用阿司匹林（或阿司匹林联合双嘧达莫）治疗是安全的，血栓栓塞事件、瓣膜血栓形成或瓣膜故障的风险很小。阿司匹林引起的出血并发症轻微且易于治疗。
