中国临床药学杂志

目的探讨机械瓣膜置换术后再手术的抗凝治疗。方法回顾并随访1997年3月-2010年1月在我科行心脏机械瓣膜置换术后并再次行其他外科手术患者96例,术前2～3 d停用华法林,检测凝血酶原国际标准化比值(INR),术后2～3 d恢复服用华法林,并依据INR调整用量。结果全组再手术患者均安全渡过围手术期,未出现血栓、颅内出血及胃肠道等异常出血。结论机械瓣膜置换术后再手术必须合理调整华法林的使用;依据INR值维持一个有效的抗凝强度,可以安全地进行手术,也可以安全地妊娠、分娩。

AIM To study the anticoagulant therapy of re-operation after mechanical valve replacement.METHODS The clinical data of 96 patients who were carried the heart mechanical valve replacement and then had the second other surgery from March 1997 to January 2010 were retrospected.All the patients stoped using warfarin 2-3 days before the second surgery and the international normalized ratio was tested.All the patients started to take warfarin which were adjusted by 2- 3 days after the second surgery.RESULTS All the patients were safe through preoperative period,and did not appear thrombosis,intracranial hemorrhage and gastrointestinal bleeding.CONCLUSION The use of warfarin should be reasonable regulated in re-operation after mechanical valve replacement.Effective anticoagulation intensity based on INR values can make the re-operation safely.It can also make the pregnancy and childbirth safely.