Application and monitoring of anticoagulation after heart valve replacement / 中国医师进修杂志

ABSTRACT

Objective To explore the best safe dose of warfarin in patients with heart valve replacement.Methods One hundred patients with heart valve replacement were selected.They were divided into ≤60 kg group(47 cases) and ＞ 60 kg group(53 cases),postoperative time ≤3 months group (39 cases) and postoperative time ＞ 3 months group(61 cases),international normalized ratio(INR) ＜ 1.5 (group Ⅰ,23 cases),INR 1.5-2.5 (group Ⅱ,66 cases),INR ＞ 2.5 (group Ⅲ,11 cases).The dose of warfarin,plasma thrombus precursor protein(TpP) and D-dimer(D-D) were compared.Results The dose of warfarin was (2.90 ± 1.11) mg in ≤ 60 kg group and (2.47 ± 0.18) mg in ＞ 60 kg group,and there was significant difference between two groups (P ＜0.05).There was no significant difference in the dose of warfarin between postoperative time ≤3 months group and postoperative time ＞ 3 months group (P＞ 0.05),but there was significant difference in TpP and D-D [(6.32 ± 0.01) mg/L vs.(4.97 ± 0.81) mg/L,(879 ± 52) μ g/L vs.(151 ± 35) μ g/L] (P ＜ 0.05).The incidence of complications was 2.6％ (1/39) in postoperative time ≤3 months group,which was lower than that in postoperative time ＞ 3 months group[18.0％(11/61)],and there was significant difference between two groups (P＜ 0.05).There was significant difference in the dose of warfarin and D-D between group Ⅰ and group Ⅱ,group Ⅲ [(2.56 ±0.21) mg vs.(2.94 ±0.57),(3.07 ±0.44) mg,(793.92 ±42.73) μg/L vs.(100.96 ± 21.56),(61.08 ± 20.34) μg/L](P＜ 0.05),but there was no significant difference between group Ⅱ and group Ⅲ (P ＞0.05).There was significant difference in TpP among three groups [(8.50 ± 0.63),(5.42 ± 0.78),(3.16 ± 0.38) mg/L in group Ⅰ,Ⅱ,Ⅲ respectively] (P ＜ 0.05).Conclusion With warfarin dose and the incidence of complications,the best dosage of wadarin is (2.94 ± 0.57) mg; the optimal range of INR is 1.5-2.5.