弁置換術後における抗凝固療法の検討

Abstract

Features of blood coagulation system and postoperative anticoagulation therapy with Warfarin on 22 patients in which cardiac valve replacement was performed, were investigated by compared to 18 patients from peripheral vascular disease.Coagulation factor VIII was increased in both group of valvular disease and vascular disease before operation. There was no tendency of increase in F. VIII during Warfarin therapy continued for 36 months after operation. Prothrombin time was not correlated well with Thrombotest nor Hepaplastintest during Warfarin therapy. Thrombotest was affected by protein induced by vitamin K abscence (PIVKA) increased above 6-8μg/ml. It was noteworthy that % F. VIII (AHF/RAG) was reduced after valve replacement surgery, as compared with vascular disease in which reconstructive surgery was performed. These results suggest that postoperative anticoagulation therapy with Warfarin should be controlled by combination of thrombotest and Hepaplastintest. Decrease in % F. VIII (AHF/RAG) might indicate the hypercoagulability induced by mechanical valve prosthesis implantation.