Moinuddeen K, Quin J, Shaw R, Dewar M, Tellides G, Kopf G, Elefteriades J
Yale University School of Medicine, New Haven, CT 06520, USA.
Circulation. 1998 Nov 10;98(19 Suppl):II95-8; discussion II98-9.
Opinion differs as to whether anticoagulation is beneficial in preventing ischemic stroke in the early postoperative period after biological aortic valve replacement (AVR). The purpose of this study was to determine whether early anticoagulation with heparin and warfarin confers any significant advantage for patients undergoing such replacement.
Patients undergoing biological AVR between 1987 and 1996 were divided retrospectively into 2 groups based on their postoperative anticoagulation. Group A (109 patients) received heparin followed by warfarin for 3 months (prothrombin time, 20 to 25 seconds). Group B (76 patients) received no postoperative anticoagulation. Patients were followed for cerebral ischemic events, bleeding, repeat operation, hospital stay, and survival. There were 5 (4.6%), 3 (2.8%), and 12 (11%) postoperative cerebral ischemic events for group A at time points of < 24 hours, 24 hours to 3 months, and > 3 months, respectively; for group B patients, 3 (3.9%), 2 (2.6%), and 9 (11.8%) events were seen during the same respective time periods. There were no statistically significant differences for ischemic events during any of these time periods for the 2 groups. Bleeding complications occurred in 10 (9.2%) group A and 7 (9.2%) group B patients. Mean hospital stay was 12 days for both groups. Repeat operative AVR was required in 6 (5.5%) group A and 7 (9.2%) group B patients. A comparison of Kaplan-Meier survival rates between groups A and B (mean follow-up, 47 +/- 26 and 59 +/- 30 months, for groups A and B, respectively) was not statistically significant (P = 0.60). Survival rates were 93%, 84%, and 62% at 1, 5, and 7 years for group A and 87%, 74%, and 67% for group B, respectively.
Early anticoagulation after AVR confers no advantage in the prevention of early cerebral ischemic events after biological AVR. No disadvantage in terms of bleeding or prolonged hospital stay was incurred by early anticoagulation. Long-term valve function and survival were not adversely affected by withholding early anticoagulation. We conclude that early anticoagulation after biological AVR is unnecessary.
对于生物主动脉瓣置换术（AVR）术后早期进行抗凝治疗是否有助于预防缺血性卒中，目前存在不同观点。本研究旨在确定早期应用肝素和华法林抗凝是否能为接受此类置换术的患者带来显著益处。
回顾性分析1987年至1996年间接受生物AVR的患者，根据术后抗凝情况将其分为2组。A组（109例患者）术后接受肝素治疗，随后服用华法林3个月（凝血酶原时间为20至25秒）。B组（76例患者）术后未进行抗凝治疗。对患者进行随访，观察脑缺血事件、出血情况、再次手术、住院时间及生存率。A组在术后<24小时、24小时至3个月、>3个月时分别发生5例（4.6%）、3例（2.8%）和12例（11%）脑缺血事件；B组患者在相同时间段内分别发生3例（3.9%）、2例（2.6%）和9例（11.8%）脑缺血事件。两组在任何时间段内的缺血事件发生率均无统计学差异。A组10例（9.2%）患者和B组7例（9.2%）患者发生出血并发症。两组的平均住院时间均为12天。A组6例（5.5%）患者和B组7例（9.2%）患者需要再次进行AVR手术。比较A组和B组的Kaplan-Meier生存率（A组和B组的平均随访时间分别为47±26个月和59±30个月），差异无统计学意义（P = 0.60）。A组在第1、5和7年的生存率分别为93%、84%和62%，B组分别为87%、74%和67%。
AVR术后早期抗凝在预防生物AVR术后早期脑缺血事件方面并无优势。早期抗凝在出血或延长住院时间方面并无不利影响。不进行早期抗凝对长期瓣膜功能和生存率没有负面影响。我们得出结论，生物AVR术后早期抗凝是不必要的。
