HEMOSTATIC CHANGES AFTER ARTIFICIAL VALVE REPLACEMENT AND ANTI-COAGULANT THERAPY

We studied hemostatic changes concerning to disseminated intravascular coagulation (DIC) and postoperative anti-coagulant thrapy in 80 patients after artificial valve replacement. They were divided in 3 groups, such as single valve replacement (S-group), double valve replacement without tricuspid va...

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Published inJinko Zoki Vol. 19; no. 1; pp. 366 - 369
Main Authors WATANABE, M., IWAYA, F., ABE, T., SATOKAWA, H., HAGIWARA, K., TANJI, M., Midorikawa, H., TAKASE, S., HOSHINO, S., TSUDA, A., TSUGUO, I., Sato, Y.
Format Journal Article
LanguageJapanese
Published JAPANESE SOCIETY FOR ARTIFICIAL ORGANS 1990
一般社団法人 日本人工臓器学会
Subjects
anti-coagulant therapy
disseminated intravascular coagulation
valve replacement
Online AccessGet full text
ISSN0300-0818
1883-6097
DOI10.11392/jsao1972.19.366

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Abstract We studied hemostatic changes concerning to disseminated intravascular coagulation (DIC) and postoperative anti-coagulant thrapy in 80 patients after artificial valve replacement. They were divided in 3 groups, such as single valve replacement (S-group), double valve replacement without tricuspid valve regurgitation (D-group) and combined valvular disease with tricuspid valve regurgitation (TR-group). The incidence of tromboembolism were 1.8%/pt-yr in S-group, 4.8%/pt-yr in D-group and 1.2%/pt-yr in TR group. The 5-year % free from thromboembolism were 82.3%, 77.9% and 87.5% respectivily. Preoperative prothombin time (PT) and thrombotest (TT) in TR-group were lower than other groups and were subject to DIC (21%). In D-group, anti-coagulant therapy tended to later after surgery and TT was higher at 3rd-7th operative day. Under anti-coagulant terapy DIC scores were improved by administration of mesilate gabexate.The anti-coagulant therapy was needed after artificial valve replacement as soon as possble.
AbstractList We studied hemostatic changes concerning to disseminated intravascular coagulation (DIC) and postoperative anti-coagulant thrapy in 80 patients after artificial valve replacement. They were divided in 3 groups, such as single valve replacement (S-group), double valve replacement without tricuspid valve regurgitation (D-group) and combined valvular disease with tricuspid valve regurgitation (TR-group). The incidence of tromboembolism were 1.8%/pt-yr in S-group, 4.8%/pt-yr in D-group and 1.2%/pt-yr in TR group. The 5-year % free from thromboembolism were 82.3%, 77.9% and 87.5% respectivily. Preoperative prothombin time (PT) and thrombotest (TT) in TR-group were lower than other groups and were subject to DIC (21%). In D-group, anti-coagulant therapy tended to later after surgery and TT was higher at 3rd-7th operative day. Under anti-coagulant terapy DIC scores were improved by administration of mesilate gabexate.The anti-coagulant therapy was needed after artificial valve replacement as soon as possble.
We studied hemostatic changes concerning to disseminated intravascular coagulation (DIC) and postoperative anti-coagulant thrapy in 80 patients after artificial valve replacement. They were divided in 3 groups, such as single valve replacement (S-group), double valve replacement without tricuspid valve regurgitation (D-group) and combined valvular disease with tricuspid valve regurgitation (TR-group). The incidence of tromboembolism were 1.8%/pt-yr in S-group, 4.8%/pt-yr in D-group and 1.2%/pt-yr in TR group. The 5-year % free from thromboembolism were 82.3%, 77.9% and 87.5% respectivily. Preoperative prothombin time (PT) and thrombotest (TT) in TR-group were lower than other groups and were subject to DIC (21%). In D-group, anti-coagulant therapy tended to later after surgery and TT was higher at 3rd-7th operative day. Under anti-coagulant terapy DIC scores were improved by administration of mesilate gabexate.The anti-coagulant therapy was needed after artificial valve replacement as soon as possble. 1985年6月より後天性弁膜疾患にて人工弁置換術を施行した80例の術後早期の凝固系の変動を測定し、DIC状態及び血栓塞栓症発生との関連について、単弁置換群34例、三尖弁閉鎖不全(TR)非合併二弁置換群13例、TR合併単弁もしくは二弁置換群33例について比較検討した。TR合併群は術前よりTT、PTが低下しており(p<0.01)出血傾向を呈する例が多く、術後DIC例はTR群で7例(21%)と多かった。術後の抗凝血薬療法の開始はTR合併群、二弁置換群で遅れる傾向にあり、二弁置換群では第3～7病日はTTが高値を示していた(P<0.05)。術後の血栓塞栓症発生頻度は単弁群1.8%/pt-yr、二弁置換群4.8%/pt-yr、TR群1.2%/pt-yr。術後5年間の%free from embolismは、単弁群82.3%、二弁置換群77.9%、TR群87.5%と二弁置換群でやや不良であった。抗凝血薬療法下でも、Mesilate gabexate併用等によりDIC scoreは改善しており、人工弁置換術後は可及的早期の抗凝血薬療法が必要である。
Author HAGIWARA, K.
IWAYA, F.
Sato, Y.
HOSHINO, S.
TANJI, M.
TSUGUO, I.
Midorikawa, H.
ABE, T.
WATANABE, M.
TAKASE, S.
TSUDA, A.
SATOKAWA, H.
Author_FL 緑川 博文
津田 晃洋
阿部 俊文
佐藤 洋一
星野 俊一
佐戸 川弘之
猪狩 次雄
萩原 賢一
岩谷 文夫
丹治 雅博
渡辺 正明
高瀬 信弥
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References 2) Dunn, G. D., Hayes, P., Breen, K. J. et al: The liver in congestive heart failure: a review. Am J Med Sci 265: 174, 1973.
3) Ferrini, P. R.: Coagulation problems related to open heart surgery. Int Anesthesiol Clin 14: 103, 1976.
4) 公文啓二, 田中一彦, 岸本康朗他: 開心術後の汎血管内凝固症候群 (DIC) に対するGabexate Mesilate (FOY) の効果. ICUとCCU6: 473, 1982.
1) 小林紀夫, 前川正, 田中広他: 慢性肝炎の凝固異常に関するアンケート調査報告 (2), 厚生省特定疾患血液凝固異常症調査研究班昭和60年度研究報告書, 47, 1986.
References_xml – reference: 4) 公文啓二, 田中一彦, 岸本康朗他: 開心術後の汎血管内凝固症候群 (DIC) に対するGabexate Mesilate (FOY) の効果. ICUとCCU6: 473, 1982.
– reference: 2) Dunn, G. D., Hayes, P., Breen, K. J. et al: The liver in congestive heart failure: a review. Am J Med Sci 265: 174, 1973.
– reference: 1) 小林紀夫, 前川正, 田中広他: 慢性肝炎の凝固異常に関するアンケート調査報告 (2), 厚生省特定疾患血液凝固異常症調査研究班昭和60年度研究報告書, 47, 1986.
– reference: 3) Ferrini, P. R.: Coagulation problems related to open heart surgery. Int Anesthesiol Clin 14: 103, 1976.
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SubjectTerms anti-coagulant therapy
disseminated intravascular coagulation
valve replacement
Title HEMOSTATIC CHANGES AFTER ARTIFICIAL VALVE REPLACEMENT AND ANTI-COAGULANT THERAPY
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