Gencbay M, Turan F, Degertekin M, Eksi N, Mutlu B, Unalp A
Kosuyolu Heart and Research Hospital, Department of Cardiology, Istanbul, Turkey.
J Heart Valve Dis. 1998 Nov;7(6):601-9.
Thrombosis is one of the most feared and life-threatening complications of mechanical heart valves (MHV), with an incidence of 1-3 per 100 patient-years. Hypercoagulable states are highly prevalent in the general population and can predispose MHV to thrombus formation. Thus, we conducted a study to investigate the frequency of hypercoagulable states in patients with MHV who had recurrent thrombosis at least twice after valve implantation.
Fifteen patients (mean age 42 +/- 11 years; range: 18 to 55 years) with recurrent thrombosis of MHV (2.4 +/- 0.8 recurrences/patient) (group 1) and 15 matched patients (mean age 40 +/- 12 years; range: 18 to 55 years) with MHV without thrombosis (group 2) were followed up with transthoracic and transesophageal echocardiography. Patients' sera were monitored for antibodies to cardiolipin (ACLA-IgG and ACLA-IgM), phosphatidylserine (APSA), lupus-type anticoagulant (LA) and lipoprotein(a) (LP(a)).
Average values for group 1 versus group 2 were: ACLA-IgG (normal range < 15 GPLU/ml) 24.7 +/- 14.6 versus 6.2 +/- 2.7 (p < 0.001); ACLA-IgM (< 12.5 MPLU/ml) 7.9 +/- 5.0 versus 3.3 +/- 1.7 (u = 185; p < 0.001); APSA (< 12 RLU/ml) 4.8 +/- 5.7 and 2.9 +/- 1.2 (p = 0.56); and LP(a) (< 30 mg/dl) 36.5 +/- 26.5 and 13.4 +/- 7.1 (p < 0.001). The frequency of LA-positive cases was 4/15 in group 1 and 0/15 in group 2 (p > 0.05). The frequency of abnormally high levels of ACLA-IgG was 9/15 in group 1 and 0/15 in group 2 (p < 0.001); of ACLA-IgM, 2/15 in group 1 and 0/15 in group 2 (p > 0.05); of APSA, 1/15 in group 1 and 0/15 in group 2 (p > 0.05); and of LP(a), 5/15 in group 1 and 0/15 in group 2 (p < 0.05). At least one of the factors included in this study was abnormal in 14 of 15 (93%) patients (p < 0.0001).
Hypercoagulable states are highly prevalent in patients with recurrent thrombosis of MHV. All patients evaluated for therapy of obstructive thrombosis of MHV should be investigated for hypercoagulable state. Moreover, in high-risk patients, surgical replacement of the MHV with a bioprosthesis should be considered.
血栓形成是机械心脏瓣膜（MHV）最可怕且危及生命的并发症之一，发病率为每100患者年1 - 3例。高凝状态在普通人群中极为普遍，可使MHV易形成血栓。因此，我们开展了一项研究，以调查瓣膜植入后至少发生两次复发性血栓形成的MHV患者中高凝状态的发生频率。
对15例MHV复发性血栓形成患者（平均年龄42±11岁；范围：18至55岁）（2.4±0.8次复发/患者）（第1组）和15例匹配的无血栓形成的MHV患者（平均年龄40±12岁；范围：18至55岁）（第2组）进行经胸和经食管超声心动图随访。检测患者血清中的抗心磷脂抗体（ACLA - IgG和ACLA - IgM）、抗磷脂酰丝氨酸抗体（APSA）、狼疮抗凝物（LA）和脂蛋白(a)（LP(a)）。
第1组与第2组的平均值如下：ACLA - IgG（正常范围<15 GPLU/ml）24.7±14.6对6.2±2.7（p<0.001）；ACLA - IgM（<12.5 MPLU/ml）7.9±5.0对3.3±1.7（u = 185；p<0.001）；APSA（<12 RLU/ml）4.8±5.7和2.9±1.2（p = 0.56）；LP(a)（<30 mg/dl）36.5±26.5和13.4±7.1（p<0.001）。第1组LA阳性病例频率为4/15，第2组为0/15（p>0.05）。ACLA - IgG水平异常升高的频率在第1组为9/15，第2组为0/15（p<0.001）；ACLA - IgM在第1组为2/15，第2组为0/15（p>0.05）；APSA在第1组为1/15，第组为0/15（p>0.05）；LP(a)在第1组为5/15，第2组为0/15（p<0.05）。本研究纳入的因素中至少有一项异常在15例患者中的14例（93%）中出现（p<0.0001）。
高凝状态在MHV复发性血栓形成患者中极为普遍。所有接受MHV阻塞性血栓形成治疗评估的患者均应检查是否存在高凝状态。此外，对于高危患者，应考虑手术更换为生物瓣膜。
