1.Adult Area Two of Cardiac Surgery, Guangdong Cardiovascular Institute Guangdong Provincial People′s Hospital Guangdong Academy of Medical Sciences Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Province, Guangzhou 510080, China;
2.Cardial Surgery Cardiovascular Center, Dongguan Kanghua Hospital, Guangdong Province, Dongguan 523000, China
Abstract：Objective To explore the monitoring strategy of Warfarin anticoagulant index prothrombin time-international normalized ratio (PT-INR) in patients after cardiac valve surgery, and to find a suitable follow-up monitoring method for patients after valvular surgery. Methods One hundred and seven patients undergoing cardiac valve surgery and requiring oral Warfarin anticoagulant therapy in Adult Area Two of Cardiac Surgery of Guangdong Provincial People′s Hospital were selected in this study from January to March 2019. According to the different anticoagulant monitoring methods, the same patient was divided into two groups: control group was taken Sodium Citrate intravenous anticoagulant and sent to the hospital laboratory, and the PT-INR results were obtained by using STAGO-E monitoring instrument produced by Sitagao Company of France, and two drops of whole blood from fingertip endings were taken from experimental group, and PT-INR results were obtained by Shenzhen qLabsPT-INR (Q1/Q3 model) coagulation detector. The correlation and deviation analysis of PT-INR between two groups of anticoagulant monitoring results were carried out, and the advantages and disadvantages of the two monitoring methods were discussed. Results There was a good correlation between the two blood coagulation monitoring instruments, the correlation coefficient R was more than 0.9, and the deviation of the results was small. It was consistent with INR (1.5-2.5) in the anticoagulation window after mechanical valvular replacement, and had good consistency and stability. The portable Shenzhen qLabs coagulation detector was easy to accept because of its convenient operation, quick result and obvious economic effect. Conclusion The portable Shenzhen qLabs blood coagulation detector has a good correlation with the large-scale instruments in the hospital, and is especially suitable for patients who are required to be treated within the treatment window after cardiac mechanical valve replacement.
[1] Xu JP，Shi YK，Dong L，et al. Low intensity anticoagulation therapy for chinese population with heart valve replacement—3000 cases follow-up [J]. Sichuan Da Xue Xue Bao Yi Xue Ban，2016，47（1）：90-92.
[2] 张瑜，游鹏程，郑秋山.115例华法林临床应用调查分析[J].中国药物警戒，2011，8（9）：524-527.
[3] Wypasek E，Ciesla M，Suder B，et al. CYP2C9 polymorphism and unstable anticoagulation with warfarin in patients within the first 3 months following heart valve replacement [J]. Adv Clin Exp Med，2015，24（4）：607-614.
[4] 郑必龙，刘俊.华法林抗凝血作用及影响因素分析[J].安徽医药，2013，17（11）：1975-1977.
[5] 中华医学会心血管病学分会，中国老年学学会心脑血管病专业委员会.华法林抗凝治疗的中国专家共识[J].中华内科杂志，2013，52（1）：76-82.
[6] Kearon C，Ginsberg JS，Kovacs MJ，et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism [J]. N Engl J Med，2003，349（7）：631-639.
[7] Gallego P，Roldan V，Marín F，et al. Cessation of oral anticoagulation in relation to mortality and the risk of thrombotic events in patients with atrial fibrillation [J]. Thromb Haemost，2013，110（6）：1189-1198.
[8] Gallagher AM，Setakis E，Plumb JM，et al. Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients [J]. Thromb Haemost，2011， 106（5）：968-977.
[9] Tsai MT，Tsai WC，Roan JN，et al. Right ventricular pacing induced heart failure after mitral valve replacement [J]. Acta Cardiol Sin，2015，31（4）：353-357.
[10] 曾颖，袁进，李小芳，等.心血管门诊患者华法林抗凝治疗现状调研分析[J].岭南心血管病杂志，2017，23（5）：566-570.
[11] 苏伟.多药联用致使华法林INR异常病例分析[J].天津药学，2016，28（1）：30-31.
[12] 刘科兰.郑州地区汉族人群的CYP2C9/VKORC1基因多态性与华法林个体化用药研究[J].中国医院用药评价与分析，2018，18（2）：261-263，267.
[13] 林清华.抗凝对心脏机械瓣膜置换术后的影响因素研究[J].中国医药科学，2018，8（18）：163-166.
[14] Heneghan C，Alonso-Coello P，Garcia-Alamino JM，et al. Self-monitoring of oral anticoagulation：systematic review and meta-analysis of individual patient data [J]. Lancet，2012，367（9508）：322-334.
[15] 陈林，蒲鹏.非瓣膜性心房颤动住院患者抗凝治疗现状调查[J].中国现代医生，2018，56（6）：131-134.
[16] Chen QL，Dong L，Dong YJ，et al. Security and cost comparison of INR self-testing andconventional hospital INR testing in patients with mechanical heart valve replacement [J]. J Cardiothorac Surg，2015，10（1）：4.
[17] 董敏，邹彤，杨杰孚，等.老年患者心房颤动的抗凝治疗[J].中国介入心脏病学杂志，2017，25（7）：403-409.
[18] 文健能.便携式凝血仪在华法林抗凝治疗监测中的应用价值[J].中国药物经济学，2016，11（6）：178-180.
[19] 李玲玲，都丽萍，梅丹.床旁即时凝血检测仪在华法林用药管理中的临床应用[J].中国卫生检验杂志，2016， 26（1）：72-73.
[20] Bussey HI. Transforming oral anticoagulation by combining international normalized ratio （INR）self testing and online automated management [J]. J Thromb Thrombolysis，2011，31（3）：265-274.
[21] Harper P，Pollock D. Improved anticoagulant control in patients using home international normalized ratio testing and decision support provided through the Internet [J]. Intern MedJ，2011，41（4）：332-337.
[22] 黄珣钡，李思阅，王霞，等.两种床旁实验凝血仪在换瓣术后抗凝监测中的临床应用[J].血栓与止血学，2013， 19（6）：274-276.
[23] Dillinger JG，SiMoussi T，Berge N，et al. Accuracy of point of care coagulometers compared to reference laboratory measurements in patients on oral anticoagulation therapy [J]. Thromb Res，2016，140（4）：66-72.
[24] van den Heuvela JK，Kenaa N，van Hattuma T，et al. Evaluation of the analytical and clinical performance of the micropoint qLabs INR point-of-care syste [J]. Thromb Res，2019，176（2）：104-107.
[25] 刘洪军，张卫红，代旻升，等.低抗凝强度华法林对非瓣膜病性心房纤颤的抗栓疗效观察[J].中国现代医生，2017， 55（26）：37-39.
[26] 杨志华，罗娜，王长奇，等.POCT凝血分析仪电化学法检测的临床应用[J].实验与检验医学，2016，34（5）：635-639.
2019, Vol. 16 
京公网安备 11010502046598号