학술논문
Acceptability of Low Intensity Anticoagulation Therapy after Mechanical Aortic Valve Replacement and the Importance of Patient's Compliance / 기계식 인공대동맥판막 치환술 후 낮은 강도 항응혈 관리의 적정성과 환자 순응도의 중요성에 관한 연구
Document Type
Dissertation/ Thesis
Author
왕청 / Wang, Qing
Source
Subject
Language
English
Abstract
배경: 기계식판막을 가진 환자의 장기간의 경구 항응혈제 치료는 혈전전색증 감소의 장점이 있는 반면 출혈 위험의 부작용도 있다. 적정한 강도의 항응혈 치료 유지와 의사의 치료방침에 대한 환자의 순응은 치료목적 달성에 중요한 요소이다. 경상대학교병원에서는 INR (국제표준화수치) 목표치 1.5-2.5의 낮은 강도의 경구 항응혈 치료를 하고 있다. 환자로 하여금 4주내지 8주의 간격으로 진료 받는 것을 치료 방침으로 하고 있다.재료 및 방법: 1990년부터 2007년까지 107례의 단일 대동맥판막치환이 행해졌다. 28례의 조직판막을 제외한 77명의 기계판막 환자를 연구대상으로 하였다. 관찰기간은 666.75 환자-년이었다. 모든 환자는 INR 관리 하에 warfarin sodium (Coumadin) 으로 항응혈 치료를 하였다. 진료기록을 후향적으로 조사하였다. 모든 환자를 1) 정상군, 2) 혈전 전색 발생군과, 3) 주요 출혈군의 세 군으로 나누었다. 사망률, 혈전전색 (TE) 과 주요 출혈발생율 (MB), INR 수치와 INR 측정간격을 분석하였다. 결과: 수술사망률은 2.597% (2/77) 이었다. 보험통계 생존율이 5년에서 84.92±4.22%, 10년 81.61±4.66%, 15년 59.96±8.10%이었다. 무 혈전전색 생존율은 5년에 97.10±2.02%, 10년에 84.30±5.22%, 15년에 67.44±12.14%이었다. 무 출혈 생존율은 5년에 90.56±3.40%, 10년에 84.18±4.77%, 15년에 77.70±7.62%이었다. 혈전전색의 선형빈도는 1.500%/pt-yr, 출혈 선형빈도는 2.099%/pt-yr이었다. 세 군의 INR 치료 목표치 (1.5-2.5) 내의 포함도 는 55.4%-59.1%로서 군 간에 차이가 없었다. 전 관찰기간 동안의 INR 평균치는 군 간에 차이가 없었다. 혈전전색이나 출혈 발생 시점 (발생일) 전 4개월간의 분할구간 INR 분석은 군 간에 매우 큰 차이를 보였다 (평균 INR: 정상군=1.857±0.135; 혈전전색군=1.504±0.279; 출혈군=2.213±0.589, p∠0.001). 발생일 이전 6개월 간의 분할구간 INR 측정 평균 간격은 군 간에 의미 있는 차이를 보이고 있다. (정상군=49.04±9.47; 혈전전색군=65.89±44.88; 주요출혈군= 35.82±20.97일, p
Background: Long-term oral anticoagulation therapy (OAC) for the patients with the mechanical prosthetic heart valves has benefit of reducing thromboembolism, but together with the side-effect of hemorrhage. Adequate maintenance of anticoagulation with optimal intensity and the patient's compliance with doctor's therapeutic strategy are important factors to accomplish treatment goal. In Gyeongsang National University Hospital (GNUH), a low intensity OAC by target international normalized ratio (INR) 1.5-2.5 has been applied. A policy recommends patients visit doctors between 4 and 8 week interval. Material and methods: One hundred and seven isolate aortic valve replacements were performed from 1990 to 2007. Excluding twenty-eight patients who received biological prosthetic valves, 77 patients with mechanical prosthetic valves were enrolled in this study. Total observation period was 666.75 patient-years. All patients were anticoagulated with warfarin sodium (Coumadin)?? by INR monitoring. Hospital records of the patients were reviewed retrospectively. All the patients were divided into three groups, 1) patients without any event (NL), 2) patients with thromboembolic event (TE), and 3) patients with major bleeding event (MB). Mortality, rates of thromboembolic event (TE) and of major bleeding (MB), INR values, and intervals of INR measurements were analyzed. Result: Operative mortality was 2.597 % (2/77). Actuarial survival rate was 84.92±4.22% at 5 years, 81.61±4.66% at 10 years, and 59.96±8.10% at 15 years. Actuarial TE free rate was 97.10±2.02% at 5 years, 84.30±5.22% at 10 years, and 67.44±12.14% at 15 years. Actuarial MB free rate was 90.56±3.40% at 5 years, 84.18±4.77% at 10 years, and 77.70±7.62% at 15 years. A linearized occurrence of TE was 1.500%/pt-yr, and MB was 2.099%/pt-yr. The percentages of mean INR within target range (1.5-2.5) of the three groups were not different (55.4%-59.1%). Three groups' mean INR values of whole follow-up period were not statistically different. Segmented 4 month-period INR analysis before the time point of events showed significant differences between groups (Mean INR: NL= 1.857±0.135; TE=1.504±0.279; MB=2.213±0.589, p≤0.001). Mean intervals of INR measurement of the segmented 6 month-period before the time point of events showed significant differences between groups (NL=49.04±9.47; TE=65.89±44.88; MB=35.82 ±20.97 days, p
Background: Long-term oral anticoagulation therapy (OAC) for the patients with the mechanical prosthetic heart valves has benefit of reducing thromboembolism, but together with the side-effect of hemorrhage. Adequate maintenance of anticoagulation with optimal intensity and the patient's compliance with doctor's therapeutic strategy are important factors to accomplish treatment goal. In Gyeongsang National University Hospital (GNUH), a low intensity OAC by target international normalized ratio (INR) 1.5-2.5 has been applied. A policy recommends patients visit doctors between 4 and 8 week interval. Material and methods: One hundred and seven isolate aortic valve replacements were performed from 1990 to 2007. Excluding twenty-eight patients who received biological prosthetic valves, 77 patients with mechanical prosthetic valves were enrolled in this study. Total observation period was 666.75 patient-years. All patients were anticoagulated with warfarin sodium (Coumadin)?? by INR monitoring. Hospital records of the patients were reviewed retrospectively. All the patients were divided into three groups, 1) patients without any event (NL), 2) patients with thromboembolic event (TE), and 3) patients with major bleeding event (MB). Mortality, rates of thromboembolic event (TE) and of major bleeding (MB), INR values, and intervals of INR measurements were analyzed. Result: Operative mortality was 2.597 % (2/77). Actuarial survival rate was 84.92±4.22% at 5 years, 81.61±4.66% at 10 years, and 59.96±8.10% at 15 years. Actuarial TE free rate was 97.10±2.02% at 5 years, 84.30±5.22% at 10 years, and 67.44±12.14% at 15 years. Actuarial MB free rate was 90.56±3.40% at 5 years, 84.18±4.77% at 10 years, and 77.70±7.62% at 15 years. A linearized occurrence of TE was 1.500%/pt-yr, and MB was 2.099%/pt-yr. The percentages of mean INR within target range (1.5-2.5) of the three groups were not different (55.4%-59.1%). Three groups' mean INR values of whole follow-up period were not statistically different. Segmented 4 month-period INR analysis before the time point of events showed significant differences between groups (Mean INR: NL= 1.857±0.135; TE=1.504±0.279; MB=2.213±0.589, p≤0.001). Mean intervals of INR measurement of the segmented 6 month-period before the time point of events showed significant differences between groups (NL=49.04±9.47; TE=65.89±44.88; MB=35.82 ±20.97 days, p