The Gastrointestinal Hemorrhage during Anticoagulation Therapy Following Mechanical Heart Valve Replacement_West China Medical Journal

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Department of Thoracic and Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;

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Keywords：

心脏瓣膜假体植入; 消化道出血; 抗凝治疗

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目的:探讨心脏机械瓣膜置换术后抗凝治疗中,消化道出血发生的危险因素及防治措施。方法:回顾性研究2001年3月至2008年7月我院16例机械瓣膜置换术后抗凝治疗中消化道出血患者的临床资料,分析发生的危险因素,并总结其诊治经验。结果:心脏机械瓣膜置换术后患者抗凝治疗中消化道出血发生在服用华法令后3天～5年,平均147.53±136.71天。其中,上消化道出血12例,下消化道出血4例;保守治疗11例,内窥镜治疗4例;死亡2例(DIC及多器官功能衰竭各1例),病死率12.5%(2/16)。出血组患者术中转流时间(142.73 min±49.81 min)明显长于对照组(98.27 min±39.52 min)(P lt;0.05),华法令平均用药量(2.46±0.53 mg/d)与对照组(2.38±0.69 mg/d)无明显差异(P gt;0.05),国际标准比值(INR)均值(2.79±0.57))明显大于对照组(1.49±0.58)(P lt;0.05)。消化道出血治疗期间停用华法令5～19天,平均13±2天,所有痊愈患者消化道出血治疗期间及出院后随访3月内均无栓塞及消化道再出血事件发生。结论;⑴心脏机械瓣膜置换术后早期(3月内)抗凝治疗发生消化道出血的危险因素包括术中转流时间过长和抗凝强度过大(INR＞2.0),晚期则可能与合并使用非甾体类抗炎药有关;⑵ 消化道出血治疗期间,华法林停用2周较为安全。

Citation： ZHANG Taiming,DONG Li,YUAN Ye,et al. The Gastrointestinal Hemorrhage during Anticoagulation Therapy Following Mechanical Heart Valve Replacement. West China Medical Journal, 2009, 24(3): 572-574. doi: Copy

1.	EMERY RW,EMERY AM,RAIKAR GV,et al.Anticoagulation for mechanical heart valves;a role for patient based therapy[J].J Thromb Thrombolysis,2008,25(1):18-25..
2.	WHITE RH,MCKITTRICK T,TAKAKUWA J, et al. Management and prognosis of lifethreatening bleeding during warfarin therapy.National Consortium of Anticoagulation Clinics[J].Arch Intern Med,1996,156(11):1197-1201..
3.	MEHTA SM,PAE WE.Complications of Cardiac surgery.In:Edmunds LH Jr,ed.Cardiac surgery in the adult[M].New York:MegrawHill,1997:389-392..
4.	OHRI SK,DESAI JB,GAER JA.Intraabdominal complications after cardiopulmonary bypass[J].Ann Thorac Surg,1991,52(3):826-831..
5.	OTT MJ,BUCHMAN TG,BAUMGARTNER W.Postoperative abdominal complications in cardiopulmonary bypass patients:A case controlled study[J].Ann Thorac Surg,1995,59(4):1210-1213..
6.	姚志发张国伟王淑霞,等.体外循环心内直视手术后缺血性胃肠道损害[J].中华胸心血管外科杂志,2006,22(3):204-205..
7.	OHNSEN SP,SORENSEN HT,MELLEMKJOER L,et al.Hospitalisation for upper gastrointestinal bleeding associated with use of oral anticoagulants[J].Thromb Haemost,2001,86:563-568..
8.	WOLF AT,WASAN SK,SALTZMAN JR.Impact of anticoagulation on rebleeding following endoscope therapy for nonvariceal upper gastrointestinal hemorrhage[J].Am J Gastroenterol,2007,102:290-296..
9.	ANANTHASUBRAMANIAM K,BCATTIE JN,ROSMAN HS,et al.How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage[J]?Chest,2001,119:478..
10.	董力,石应康.心脏机械瓣膜置换术后抗凝治疗[J].中国胸心血管外科临床杂志,2004,11(1):63-67..
11.	FILSOUFI F,RAHMANIAN PB,CASTILLO JG,et al.Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery[J].Ann Surg.2007,246(2):323-329..
12.	BEYTH RJ,QUINN LM,LANDEFELD CS.Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin[J].Am J Med,1998,105(2):91-99..
13.	VONBACH P,REICH R,M?LL F,et al.Risk factors for gastrointestinal bleeding:a hospitalbased casecontrol study[J].Swiss Med Wkly,2007,137(4950):705-710..

1. EMERY RW,EMERY AM,RAIKAR GV,et al.Anticoagulation for mechanical heart valves;a role for patient based therapy[J].J Thromb Thrombolysis,2008,25(1):18-25..
2. WHITE RH,MCKITTRICK T,TAKAKUWA J, et al. Management and prognosis of lifethreatening bleeding during warfarin therapy.National Consortium of Anticoagulation Clinics[J].Arch Intern Med,1996,156(11):1197-1201..
3. MEHTA SM,PAE WE.Complications of Cardiac surgery.In:Edmunds LH Jr,ed.Cardiac surgery in the adult[M].New York:MegrawHill,1997:389-392..
4. OHRI SK,DESAI JB,GAER JA.Intraabdominal complications after cardiopulmonary bypass[J].Ann Thorac Surg,1991,52(3):826-831..
5. OTT MJ,BUCHMAN TG,BAUMGARTNER W.Postoperative abdominal complications in cardiopulmonary bypass patients:A case controlled study[J].Ann Thorac Surg,1995,59(4):1210-1213..
6. 姚志发张国伟王淑霞,等.体外循环心内直视手术后缺血性胃肠道损害[J].中华胸心血管外科杂志,2006,22(3):204-205..
7. OHNSEN SP,SORENSEN HT,MELLEMKJOER L,et al.Hospitalisation for upper gastrointestinal bleeding associated with use of oral anticoagulants[J].Thromb Haemost,2001,86:563-568..
8. WOLF AT,WASAN SK,SALTZMAN JR.Impact of anticoagulation on rebleeding following endoscope therapy for nonvariceal upper gastrointestinal hemorrhage[J].Am J Gastroenterol,2007,102:290-296..
9. ANANTHASUBRAMANIAM K,BCATTIE JN,ROSMAN HS,et al.How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage[J]?Chest,2001,119:478..
10. 董力,石应康.心脏机械瓣膜置换术后抗凝治疗[J].中国胸心血管外科临床杂志,2004,11(1):63-67..
11. FILSOUFI F,RAHMANIAN PB,CASTILLO JG,et al.Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery[J].Ann Surg.2007,246(2):323-329..
12. BEYTH RJ,QUINN LM,LANDEFELD CS.Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin[J].Am J Med,1998,105(2):91-99..
13. VONBACH P,REICH R,M?LL F,et al.Risk factors for gastrointestinal bleeding:a hospitalbased casecontrol study[J].Swiss Med Wkly,2007,137(4950):705-710..

West China Medical Journal

The Gastrointestinal Hemorrhage during Anticoagulation Therapy Following Mechanical Heart Valve Replacement

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