Katholi R E, Nolan S P, McGuire L B
Am Heart J. 1976 Aug;92(2):162-7. doi: 10.1016/s0002-8703(76)80251-7.
A total of 111 survivors of prosthetic valve insertion were followed an average of 4 years to assess the risk of thromboembolism or hemorrhage. Non-cloth-covered ball and/or disc valve prostheses were used, and all patients received long-term anticoagulant therapy. During the follow-up period the patients with mitral or combined valve replacement suffered four times more thromboembolic episodes and had a poorer survival rate than the patients with isolated aortic valve replacement. The management of anticoagulation and the complications resulting from 44 subsequent noncardiac operations were analyzed. Anticoagulation was discontinued before 25 noncardiac operations in patients with isolated aortic valve prostheses and there were no perioperative thromboemboli. Ten operations were performed on patients with mitral or combined valve prostheses with cessation of anticoagulation prior to surgery and there were two deaths due to perioperative thromboemboli. Unanticipated hemorrhage was encountered in four of nine patients in whom anticoagulation was maintained during surgery. Cessation of anticoagulation for 3 to 5 days appears safe in patients with aortic prostheses who require subsequent noncardiac operations. The incidence of thromboembolism in patients after mitral or combined valve replacement is high and constitutes a major risk whether or not a subsequent operation is required.
对总共111例人工瓣膜植入幸存者进行了平均4年的随访，以评估血栓栓塞或出血的风险。使用了非布覆盖的球和/或盘式瓣膜假体，所有患者均接受长期抗凝治疗。在随访期间，二尖瓣置换或联合瓣膜置换的患者发生血栓栓塞事件的次数是单纯主动脉瓣置换患者的四倍，且生存率更低。分析了抗凝管理以及随后44例非心脏手术引起的并发症。单纯主动脉瓣假体患者在25例非心脏手术前停用了抗凝药物，且无围手术期血栓栓塞事件发生。对10例二尖瓣或联合瓣膜假体患者在手术前停用抗凝药物后进行了手术，有2例患者因围手术期血栓栓塞死亡。9例在手术期间维持抗凝治疗的患者中有4例发生了意外出血。对于需要进行后续非心脏手术的主动脉假体患者，停用抗凝药物3至5天似乎是安全的。二尖瓣置换或联合瓣膜置换患者的血栓栓塞发生率很高，无论是否需要进行后续手术，都是一个主要风险。
