[在机械心脏门更换后,中国患者的抗凝强度的目标值]
1Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua yi xue za zhi
|August 14, 2023
概括
对于接受机械心脏置换的中国患者,建议目标国际规范比率 (INR) 为1.5-2.5. 较低的INR范围 (1.5-2.0) 对于低风险的大动脉或二心置换患者是最佳的,而较高的范围 (2.0-2.5) 适合其他患者.
科学领域:
- 心血管医学 心血管医学
- 临床药理学 临床药理学
- 生物医学工程 生物医学工程
背景情况:
- 机械心脏门置换需要有效的抗凝药来预防血栓栓塞事件.
- 通过国际规范化比率 (INR) 测量抗凝剂的最佳强度的确定对于患者的结果至关重要.
- 以前的指导方针可能无法完全满足中国患者群体在门更换后的特定需求.
研究的目的:
- 确定最佳目标国际规范比率 (INR) 范围,用于在机械心脏门置换后在中国患者中进行抗凝治疗.
- 为了在这个特定的患者队列中比较不同INR强度的抗凝血相关并发症率.
- 为中国患者量身定制的抗凝管理提供基于证据的建议.
主要方法:
- 一项前性的多中心队列研究,分析了来自中国35个医疗中心的数据.
- 包括2011年1月至2015年12月期间住院和门诊患者的数据.
- 对抗凝血相关并发症的分析与不同的INR水平相关,包括特定的子组,如大动脉置换 (AVR),中枢置换 (MVR) 和双置换 (DVR).
主要成果:
- 总共有24,433名患者被分析,随访时间中位数为19.2个月.
- 与INR<1.5 (1.31/100患者年) 或INR>2.5 (2.34/100患者年) 的患者相比,INR范围为1.5-2.5的患者表现出与抗凝血相关并发症 (0.65/100患者年) 的比率明显较低.
- 确定了特定的最佳INR范围:低风险孤立AVR或MVR的1.5-2.0,高风险AVR/MVR,三管置换 (TVR) 或DVR的2.0-2.5.
结论:
- 在机械心脏门置换后,建议中国患者的目标INR范围为1.5-2.5.
- 根据门类型和患者风险因素量身定制的INR目标可以进一步优化抗凝治疗并最大限度地减少并发症.
- 这些发现支持个性化抗凝策略,以提高这一群体的安全性和有效性.
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