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抗凝固剤を義肢の血栓性および患者のリスク要因に調整する. メドトロニックのホールバルブに関する推奨事項
E G Butchart1, P A Lewis, J A Bethel
1Department of Cardiac Surgery, University Hospital, Cardiff, Wales, UK.
Circulation
|November 1, 1991
まとめ
メドトロニック・ホールバルブ患者の場合,ミトラルバルブ置換術 (MVR) の後には国際標準比 (INR) 3.0が最適であり,大動脈弁置換術 (AVR) の後には2.5が最適である. 脳卒中のリスク要因は,これらの勧告に影響を与えます.
科学分野:
- 心臓病学 心臓病学
- バイオメディカルエンジニアリング
- クリニック・トライアル 臨床試験
背景:
- メドトロニック・ホールのメカニカルバルブは,心臓弁の置換に広く使用されています.
- 最適な抗凝固レベルを決定することは,患者の安全と弁の機能にとって非常に重要です.
- 以前の研究では,機械弁の抗凝固標的が異なることを示唆していました.
研究 の 目的:
- メドトロニック・ホールバルブの最適の抗凝固レベル (国際標準化比率 (INR)) を決定する.
- ミトラ弁置換 (MVR) と大動脈弁置換 (AVR) の後の異なるINRレベルでのイベントフリー生存率を比較する.
主な方法:
- 345人のMVRと241人のAVR患者をメドトロニックのホールバルブで分析したレトロスペクティブ研究.
- 患者は,低 (平均INR 2.5) と中等 (平均INR 3.0) の抗凝固薬群に分類されました.
- イベントフリー生存率 (血栓塞栓,栓塞,出血) は3年間で計算されました.
主要な成果:
- バルブ血栓症は,どのグループでも発生しなかった.
- ミトラ弁置換 (MVR):適度な抗凝固薬 (INR 3.0) は,3年後に低 (80%) よりも高いイベントフリー生存率 (89%) を示しました.
- 大動脈弁置換 (AVR):低抗凝固 (INR 2.5) は,エボリックおよび出血事件が少ない中等 (87%) と比較して,優れたイベントフリー生存率 (99%) を示しました.
結論:
- メドトロニックホールバルブの最適なINRは,MVR後に3.0で,AVR後に2.5です.
- 脳卒中のリスク要因は,個別の抗凝固調整を必要とします.
- 脳卒中の危険因子を持たない患者は,抗凝固剤の強度に関係なく,血栓性イベントを経験しなかった.
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