Björk V O, Henze A
Scand J Thorac Cardiovasc Surg. 1975;9(3):183-91. doi: 10.3109/14017437509138637.
Dicumarol anticoagulation poved very effective in the prevention of thromboembolic complications after aortic valve replacement with the Björk-Shiley tilting disc valve. We have, however, encountered six late deaths because of massive cerebral hemorrhage, which represent 3% of the patients who were maintained on dicumarol medication at that time. This unacceptable mortality prompted us to introduce two programmes, one without anticoagulation and another one with dipyridamole-acetylsalicylic acid. Furthermore, dicumarol was terminated in patients with haemorrhagic episodes, instable anticoagulation, pregnancy, and in those reguiring surgery. The results were disappointing, however, and the majority of the patients involved were therefore put on dicumarol medication. Eleven of the 64 consecutive patients taking dipyridamole - acetylsalicylic acid had thrombo-embolic episodes during a mean follow-up period of 9 months...
双香豆素抗凝在预防使用比约克-希利倾斜碟瓣进行主动脉瓣置换术后的血栓栓塞并发症方面证明非常有效。然而，我们遇到了6例因大量脑出血导致的晚期死亡病例，占当时接受双香豆素治疗患者的3%。这种不可接受的死亡率促使我们引入了两个方案，一个是不进行抗凝，另一个是使用双嘧达莫-乙酰水杨酸。此外，对于有出血发作、抗凝不稳定、怀孕以及需要手术的患者，停用了双香豆素。然而，结果令人失望，因此大多数相关患者又开始使用双香豆素治疗。在平均9个月的随访期内，连续服用双嘧达莫-乙酰水杨酸的64例患者中有11例发生了血栓栓塞事件……
