高危动脉栓塞患者需暂时中断华法林时低分子肝素过渡治疗的单肢研究

作     者：Kovacs M.J. Kearon C. Rodger M. 王永兴 

作者机构：Kovacs London Health Sciences Centre 800 Commissioners Rd E London Ont. N6A 4G5 Canada Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第2期

页      面：28-29页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：低分子肝素 动脉栓塞 血栓栓塞事件 心源性栓塞 人工瓣膜 外科手术 队列研究 于术 学术中心 

摘      要：Background When warfarin is interrupted for surgery, low molecular weight h eparin is often used as bridging therapy. However, this practice has never been evaluated in a large prospective study. This study was designed to assess the ef ficacy and safety of bridging therapy with low molecular weight heparin initia ted out of hospital. Methods and Results This was a prospective, multicenter, s ingle arm cohort study of patients at high risk of arterial embolism (prostheti c valves and atrial fibrillation with a major risk factor). Warfarin was held fo r 5 days preoperatively. Low molecular weight heparin was given 3 days preoper atively and at least 4 days postoperatively. Patients were followed up for 3 mon ths for thromboembolism and bleeding. Eleven Canadian tertiary care academic cen ters participated; 224 patients were enrolled. Eight patients (3.6%; 95%CI, 1. 8 to 6.9) had an episode of thromboembolism, of which 2(0.9%; 95%CI, 0.2 to 3. 2) were judged to be due to cardioembolism. Of these 8 episodes of thromboemboli sm, 6 occurred in patients who had warfarin deferred or withdrawn because of ble eding. There were 15 episodes of major bleeding(6.7%; 95%CI, 4.1 to 10.8): 8 o ccurred intraoperatively or early postoperatively before low molecular weight heparin was restarted, 5 occurred in the first postoperative week after low mol ecular weight heparin was restarted, and 2 occurred well after low molecular weight heparin was stopped. There were no deaths. Conclusions Bridging therapy with subcutaneous low molecular weight heparin is feasible; however, the optimal approach for the management o f patients who require temporary interruption of warfarin to have invasive proce dures is uncertain.