Abstract: Objective To study the strategy of warfarin anticoagulation and the relationship between age, gender, body weight and the coagulation dose，efficacy of warfarin, after mechanical heart valve replacement. Methods From September 2006 to September 2008, the clinical data of 192 cases received mechanical heart valve replacement and used warfarin anticoagulation therapy after operation were analyzed retrospectively. Results In this group, because of warfarin used overdose, 1 case died from intracranial bleeding and 1 case occurred extensive subcutaneous bleeding and severe nasal bleeding, 1 case occurred luminal space cerebral infraction (only single use of warfarin). 2 cases were ineffective in the only use of warfarin, but after combination with aspirin, the INR could adjust to the target range. The other cases had a good result, no severe bleeding and thrombosis were found. Conclusion Maintain dose of warfarin anticoagulation has a great individual difference after mechanical heart valve replacement. It not correlated with age, gender and body weight. To maintain anticoagulation therapy INR at 1.8 to 2.5 is appropriate, which dose not increase the risk of bleeding and thrombosis.

摘要： 目的　研究心脏机械瓣膜置换术后华法林抗凝的调整策略及年龄、性别、体重与华法林抗凝剂量、疗效的关系。方法　对我科在2006年9月到2008奶奶9月施行192例心脏机械瓣膜置换术后服用华法林抗凝治疗的临床资料进行回顾性分析。结果 本组1例因过量服用华法林出现颅内出血死亡，1例过量出现严重皮下出血及鼻出血，1例出现腔隙性脑梗，2例单用华法林效果不佳，合用拜阿司匹林后INR可调整到目标范围；其余患者效果较好，无严重出血及血栓形成。结论 心脏机械瓣膜置换术后华法林抗凝维持剂量个体差异较大，与年龄、性别、体重无关；抗凝治疗维持INR在1.8～2.5较为适宜，不增加出血及血栓形成风险。

关键词: 机械瓣膜置换, 华法林, 国际标准化比值, Mechanical valve replacement, Warfarin, International normalized ratio