机械心脏二尖瓣置换术后低剂量阿司匹林联合华法林的安全性和有效性评价

Bangladesh Heart Journal Pub Date : 2021-09-20 DOI:10.3329/bhj.v36i1.55514

Md Sorower Hossain, Istiaq Ahmed, S. Raha, S. Biswas, Md. Kamrul Hasan

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引用次数: 0

摘要

简介:推荐在机械瓣膜置换术后使用华法林以预防血栓栓塞并发症。华法林和阿司匹林联合用药可进一步减少这些患者的血栓栓塞事件。本研究旨在评价机械二尖瓣置换术后低剂量阿司匹林和华法林联合治疗的安全性和有效性。材料与方法:选择99例机械二尖瓣置换术患者分为两组。A组患者(50例)联合小剂量阿司匹林(75mg)和华法林。B组49例患者单独给予常规剂量华法林治疗。国际标准化比值(INR)指标A组为1.8 ~ 2.4,B组为2.5 ~ 3.5。两组患者术后INR、血栓栓塞事件、抗凝相关出血及其他发病率和死亡率均有记录。结果:术后随访9个月。A组华法林平均剂量为4.36±0.31 mg, B组华法林平均剂量为5.57±0.52 mg (p<0.001)。两组患者总体平均INR差异有统计学意义(P<0.001)， A组患者INR低(2.19±0.13)，B组患者INR低(3.03±0.31)。A组血栓栓塞事件发生率(0.02例/患者年)低于B组(0.08例/患者年)。两组患者出血发生率差异无统计学意义(p=0.362)，但资料显示华法林加阿司匹林组患者出现轻微出血的比例较高。结论:机械二尖瓣置换术后，联合使用阿司匹林(75mg)和低剂量华法林，目的是将INR维持在1.8 - 2.4之间(低于推荐的2.5-3.5)，可能在血栓形成、栓塞和出血方面提供满意的结果，而不会增加死亡率。孟加拉国心脏杂志2021;36 (1): 24-31

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Evaluation of Safety and Efficacy of Combined Low Dose Aspirin and Warfarin Following Mechanical Heart Valve Replacement for Mitral Valve Disease

Introduction: Warfarin is recommended following mechanical valve replacement to prevent thromboembolic complications. A combination of warfarin and aspirin may further reduce thromboembolic events in these patients. This study was designed to evaluate safety and efficacy of combined low dose aspirin and warfarin therapy following mechanical mitral valve replacement. Materials and Methods: Purposively selected 99 patients who underwent mechanical mitral valve replacement were divided into two groups. Patients of Group A (n=50) received combined low dose aspirin (75mg) and warfarin. Patients of Group B (n=49) received conventional dose of warfarin alone. International normalized ratio (INR) was targeted 1.8-2.4 for group A Patients and 2.5-3.5 for group B Patients. Post-operatively INR, thromboembolic events, anti-coagulation related haemorrhage and other morbidity and mortality were registered in both groups. Result: Patients were followed up postoperatively for 9 months. The mean dose of warfarin in group A and group B was 4.36 ± 0.31 mg and 5.57±0.52 mg respectively (p<0.001). The overall mean INR of two groups of patients were statistically different (P<0.001) with low INR in group A (2.19±0.13) patients compared to group B (3.03±0.31). The thromboembolic events in group A (0.02/patient year) were lower than those in group B (0.08/Patient year). There was no statistically significant (p=0.362) difference in bleeding episodes between two groups but data indicate proportion of minor bleeding manifestations were higher in patients treated with warfarin plus aspirin group. Conclusion: Following mechanical mitral valve replacement, a combination of aspirin (75mg) and low dose warfarin with an aim to maintain INR between 1.8 and 2.4 (lower than recommended 2.5-3.5) may provide satisfactory outcomes in term of thrombosis, embolism and bleeding without increase in mortality. Bangladesh Heart Journal 2021; 36(1): 24-31

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Bangladesh Heart Journal

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