心脏机械瓣置换后特殊情况抗血栓治疗的临床研究

目的:探讨机械瓣置换后特殊情况抗血栓治疗方案的疗效和安全性。方法:对于机械瓣置换后病人妊娠、分娩,INR在目标值范围内月经过多,人流手术等不同特殊情况制定不同的抗血栓治疗方案。妊娠在头6～12周改为低分子肝素,每次0.01 ml·kg-1,1日2次,皮下注射,剖腹产前1周停华法令,前4天改为低分子肝素,后3天改为普通肝素持续静脉泵入,按APTT为正常值的2～3倍来调整剂量,术前6～12小时停用普通肝素,手术后无出血24小时内服用华法令。血栓高危患者择期大手术、人流手术按剖腹产术前准备。急性兰尾炎手术给予小剂量维生素K。INR在目标值范围的妇女月经过多者,在月经的第1天停用华法令1次。眼科白内障手术、拔牙手术及皮肤癌手术无需调整INR。结果:剖腹产围手术期顺利,新生儿健康。所有手术无大出血和血栓事件。INR在目标值范围月经过多的妇女,有效率达94％（32/34例）。结论:本组为机械瓣置换后特殊情况所制定的抗血栓方案疗效满意;是否为较成熟方案,尚需临床实践进一步证实。

Clinical study of efficacy and safety of antithrombotic therapy in special groups of the patients with prosthetic heart mechanical valves

Objective: To evaluate the efficacy and the safety of antithrombotic therapy in special groups of the patients with prosthetic heart mechanical valves. Methods: Three women with prosthetic mechanical valves were pregnant. 34 patients had exceeding bleeding in menstrual phase when values of INR (international normalized ratio) were right. Twelve patients underwent induced abortion. uterine neoplasitc resection. cholecystectomy, appendectomy cataract operation, dermal carcinectomy and exodontia respectively. The antithrombotic therapies of individual should are dissimilarity in special groups of the patients. Warfarin should be avoided between 6 and 12 weeks of gestation to avoid embryopathy replaced by LMWH (low molecular-weight heparins). In 1 week before cesarean Warfarin was replaced by LMWH (in 4 days early), standard heparin (in 3 days last). Stop heparin in 6-12 hour before cesarean. Warfarin was administered within 24h after operation. Antithrombotic therapies of major operations and induced abortion were alike as delivery. In first day of menstrual phase the Warfarin was ceased. The patients underwent cataract operation and exodontea or dermal carcinectomy didn't change level of INR. Results: The pregnant women were favoring delivery. All neonatal babies were healthy. Effective rate was 94% in woman with menstrual phase. Severe bleeding or events of thrombotic not observed in whole patients. Conclusion: Efficacy and safety of our own antithrombotic therapies are satisfactory in special patients with prosthetic heart mechanical valves.