老年患者机械瓣膜替换术后合理抗凝治疗研究

目的 探讨老年患者机械瓣膜替换术后合理抗凝治疗。方法 将129例患者分为2组,A组年龄≥65岁(30例),B组年龄<65岁(99例),随访2～79个月,比较不同年龄组在不同抗凝强度下血栓栓塞和出血发生率,观察抗凝效果。结果 随访期间共发生与抗凝有关的出血16例,血栓栓塞6例,其中A组分别为4例(13.3％)和2例(6.7％),B组12例(12.1％)和4例(4.0％)。死亡4例(3.1％),A组1例(3.3％),B组3例(3.0％)。在同一抗凝水平下,A、B两组血栓栓塞和出血发生率差异无显著性意义,抗凝治疗期间国际标准化比值(INR)长时间低于1.65或高于2.50者,血栓栓塞和出血发生率高于INR 1.65～2.50水平者。结论 老年患者机械瓣膜替换术后维持INR为1.65～2.50,可有效减少抗凝并发症。

Study on Optimal Anticoagulant Therapy in Older Patients with Mechanical Prosthetic Valves

Objective To explore the target anticoagulant range in older patients with mechanical prosthetic valves. Methods 129 patients treated with Warfarin were followed up for 2-79 months and divided into 2 groups by age at the time of operation. The age of the patients in group A (n=30) was 65 years old or more and that in group B (n= 99) less than 65. Results Of the 22 patients who suffered from anticoagulant-related complications, 16 were confirmed to have bleeding (group A, 4; group B, 12) and 6 throm-boembolic episodes (group A, 2; group B, 4). Four patients died of the complications (group A, 1; group B, 3) with a mortality rate of 3. 1 %. The incidence of bleeding and thromboembolic episodes was not statistically different between the two age groups at the same anticoagulant level. The rates of bleeding in INR>2. 50 or thromboembolism in INR<1. 65 were higher than that in 1. 65 to 2. 50 of INR during anticoagulant therapy. Conclusion In older patients with mechanical prosthetic valves, an INR of 1. 65 to 2. 50 might be an ideal range resulting in good protection from thromboembolism and bleeding.