摘要
目的:通过系统评价探讨华人心脏机械瓣膜置换术后的抗凝标准。方法:以瓣膜术后的总体抗凝标准和二尖瓣与主动脉瓣单瓣置换的抗凝标准为研究对象,检索相关文献,对入选文献按随机效应模型进行系统评价,将总体抗凝标准分为A、B两组:A组的平均目标国际标准化比值(INR)≤2.0,B组平均目标INR>2.0。结果:27篇文献纳入研究,共包括5609例患者。A组血栓栓塞率较B组高(RR=4.3,P<0.01),但出血和总事件发生率明显降低(RR=0.41,P<0.01;RR=0.67,P<0.01)。在抗凝目标INR≤2.0的亚组分析中,主动脉瓣置换组经抗凝治疗后血栓栓塞率较二尖瓣置换组更低(RR=0.40,P<0.01),而出血和总事件发生率两组无明显统计学差异(RR=1.08,P>0.05;RR=0.86,P>0.05)。结论:对于心脏机械瓣膜置换术后的华人患者,术后抗凝治疗以达到INR≤2.0较为有利,建议将抗凝标准控制在INR1.5～2.0。主动脉瓣单瓣置换术后理想的INR范围在1.5～1.8,二尖瓣单瓣置换术后INR在1.8～2.0为宜。
Objective： The aim of this systematic review was to study Chinese optimal anticoagulation intensity with warfarin after mechanical heart valve replacement （MHVR）. Methods： A systematic review was performed of all selected articles with data on incidences of thromboembolic and bleeding complications using random effect model. This study consisted of two parts： overall optimal antieoagulation intensity after MHVR and ideal international normalized ratio （INR） after mitral valve replacement （MVR） and aortic valve replacement （AVR）. The study of overall optimal anticoagulation intensity was classified into two groups. Group A was characterized by mean target INR of 2.0 or lower, while group B was characterized by mean target INR above 2. 0. Results： 27 eligible studies were identified, including a total of 5,609 patients. Group A had a higher incidences of thromboembolism （RR = 4.3, P〈0.01 ） and a lower incidences of bleeding and total complications （RR = 0.41, P〈0.01, RR - 0.67, P〈0.01）. Under mean target INR of 2.0 or lower, patients with anticoagulation therapy after AVR had a lower incidences of thromboembolism comparing MVR （RR = 0.40, P〈0.01 ）. However, the incidences of bleeding and total complications had no statistical significance （RR = 1.08, P〉0.05, RR = 0.86, P〉0. 05）. Conclusion： INR levels ranged from 1.5-2. 0 are recommended for Chinese patients with anticoagulation treatment after MHVR. AVR and MVR may benefit from a treatment strategy with INR levels ranged from 1.5-1.8 and 1.8-2.0.
出处
《国际心血管病杂志》
2010年第6期361-366,共6页
International Journal of Cardiovascular Disease
关键词
华人
机械瓣膜置换
国际标准化比值
华法林
Chinese
Heart valve replacement
International normalized ratio
Warfarin
