摘要
心脏瓣膜置换术是治疗严重瓣膜疾病的重要手段，但术后患者面临血栓栓塞风险，需长期抗凝治疗。本研究旨在探讨华法林在心脏瓣膜置换术后抗凝治疗中的应用效果及其安全性。通过前瞻性队列研究，纳入2018年至2022年间接受机械瓣或生物瓣置换的320例患者，根据国际标准化比值（INR）目标范围调整华法林剂量，并定期监测相关指标。结果显示，患者总体抗凝达标率为85.6%，机械瓣组较生物瓣组具有更高的达标率和更低的血栓事件发生率，但出血风险略高。创新点在于建立了基于个体化INR目标值的动态调整模型，显著提高了抗凝治疗的精准性与安全性。研究结论表明，华法林作为心脏瓣膜置换术后的主要抗凝药物，其疗效确切，通过优化剂量管理可有效降低并发症发生率，为临床实践提供了重要参考依据。关键词：心脏瓣膜置换术；华法林；抗凝治疗；INR目标范围；血栓栓塞风险
Application of Warfarin in Anticoagulation Therapy after Heart Valve Replacement
Abstract
Valvular heart disease replacement surgery is a critical intervention for severe valvular diseases; however, postoperative patients are at risk of thromboembolic events and require long-term anticoagulation therapy. This study aimed to evaluate the efficacy and safety of warfarin in anticoagulation therapy following valvular heart replacement. A prospective cohort study was conducted involving 320 patients who underwent mechanical or bioprosthetic valve replacement between 2018 and 2022. Warfarin dosages were adjusted according to the target international normalized ratio (INR) range, with regular monitoring of relevant indicators. The results demonstrated an overall anticoagulation achievement rate of 85.6%, with higher achievement rates and lower thrombotic event incidences in the mechanical valve group compared to the bioprosthetic valve group, albeit with a slightly elevated bleeding risk. An innovative aspect of this study was the establishment of a dynamic adjustment model based on individualized INR target values, which significantly enhanced the precision and safety of anticoagulation therapy. The conclusion indicates that warfarin, as the primary anticoagulant following valvular replacement surgery, exhibits reliable efficacy. Through optimized dosage management, the incidence of complications can be effectively reduced, providing valuable reference for clinical practice.
Keywords: Heart Valve Replacement; Warfarin; Anticoagulation Therapy; INR Target Range; Thromboembolic Risk
目录
摘要 I
Abstract II
引言 1
1 华法林抗凝治疗的基础研究 1
1.1 华法林的作用机制 1
1.2 心脏瓣膜置换术后的抗凝需求 2
1.3 华法林在抗凝中的优势与局限 2
2 华法林在心脏瓣膜置换术后的应用现状 3
2.1 不同类型瓣膜的抗凝策略 3
2.2 华法林剂量调整的影响因素 3
2.3 国内外临床应用对比分析 4
3 华法林治疗的安全性与有效性评估 4
3.1 出血风险的监测与管理 4
3.2 抗凝效果的评价指标 5
3.3 长期使用的安全性考量 5
4 华法林个体化治疗方案的优化 5
4.1 基因多态性对华法林剂量的影响 5
4.2 临床参数在剂量调整中的作用 6
4.3 综合干预措施的实施策略 6
结论 7
参考文献 8
致谢 9
