기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구
Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low...
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| creator | 김종우 이상호 김영춘 양준호 장인석 최준영 Kim, Jong-Woo Rhie, Sang-Ho Kim, Young-Chun Yang, Jun-Ho Jang, In-Seok Choi, Jun-Young |
| description | Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p |
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| fullrecord | <record><control><sourceid>kisti</sourceid><recordid>TN_cdi_kisti_ndsl_JAKO200911850422063</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>JAKO200911850422063</sourcerecordid><originalsourceid>FETCH-kisti_ndsl_JAKO2009118504220633</originalsourceid><addsrcrecordid>eNpjYeA0MDYw1DWyMLXkYOAtLs5MMjA2MzK3MDU15mTIeLVjw6vNLW-65yq8mbvj1eatCm-617yZt_Rtz4TXyzsV3uyc8XbmjDcdCxTezm5ReN207s3cBoVXG6a-7m9ReDt17Zu5E9_O6FB4taXh9bI1b-bOUHizoPHNgqlvWja-mT4BJPx26hyFN9M3vNq6hoeBNS0xpziVF0pzM6i6uYY4e-hmZxaXZMbnpRTnxHs5evsbGRhYGhpamBqYGBkZmBkbE6sOADMKYyI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구</title><source>KoreaMed Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>김종우 ; 이상호 ; 김영춘 ; 양준호 ; 장인석 ; 최준영 ; Kim, Jong-Woo ; Rhie, Sang-Ho ; Kim, Young-Chun ; Yang, Jun-Ho ; Jang, In-Seok ; Choi, Jun-Young</creator><creatorcontrib>김종우 ; 이상호 ; 김영춘 ; 양준호 ; 장인석 ; 최준영 ; Kim, Jong-Woo ; Rhie, Sang-Ho ; Kim, Young-Chun ; Yang, Jun-Ho ; Jang, In-Seok ; Choi, Jun-Young</creatorcontrib><description>Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy. 배경: 기계식 인공 심장판막 치환 수술을 받은 환자들에 있어서 장기간의 경구 항응고제 투여는 반드시 필요하다. 그러나 이러한 환자들에 있어서 혈색전증의 발생을 예방하는 동시에 출혈을 방지하기 위한 적절한 항응고제의 용량에 관해서는 아직까지 논의의 소지가 있다. 저자들은 INR (International Normalized Ratios)을 1.5에서 2.5사이에 두는 낮은 강도 항응혈 관리를 적용하여 장기 추적관찰 결과를 분석하였다. 대상 및 방법: 1992년 1월부터 2002년 12월까지 144명의 단일 심장판막 치환 수술을 받은 환자를 대상으로 하였다. 평균연령은 47.4세였고$(15{\sim}72)$, 대동맥판막 치환수술을 받은 환자는 49명, 승모판막 치환수술을 받은 환자는 95명이었다. 이들의 항응고 수치와 임상 결과를 분석하였다. 환자들은 본원 외래로 $1{\sim}2$개월에 한번씩 임상관찰 추적하고 prothrombin time을 측정하여 INR을 낮은 강도 항응혈 목표치인 1.5와 2.5사이에 유지하려 하였다. 결과: 총 144명의 환자에서 추적관찰 기간은 835.3 환자년(평균 $5.9{\pm}3.5$)이었으며 7,706개의 INR측정치가 평가의 대상이었다 승모판막 치환수술군과 대동맥판막 치환수술군 간에 INR 수치는 유의한 차이를 보였다(p<0.01). 모든 환자의 INR측정 수치의 61.9%가 목표 범위 내에 있었다. 심방세동이 있는 환자는 전체의 30.3%였으며 그들의 INR 측정치$(2.16{\pm}0.23)$는 동율동 환자들의 INR 측정치$(2.03{\pm}0.27)$보다 유의하게 높았다(p<0.01). 혈색전증은 9명의 환자에서 보였으며 1.08%/환자년의 발생율을 보였다. 주요 출혈은 2명의 환자에서 발생하였고 발생율은 0.24%/환자년이었다. 환자의 순응도가 좋을수록 합병증 발생율이 유의하게 낮았다(p=0.000). 결론: 단일 대동맥판막 또는 승모판막 치환술 후 항응혈 치료에서 낮은 강도의 INR 목표범위로도 효과적이고 안전한 항응혈 치료가 가능하다는 것을 시사하며 더 효과적인 항응혈 치료를 위해서는 환자의 순응도를 높여야 될 것으로 사료된다.</description><identifier>ISSN: 0301-2859</identifier><language>kor</language><ispartof>Taehan Hyungbu Oekwa Hakhoe chi, 2009, Vol.42 (2), p.193-200</ispartof><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4010</link.rule.ids></links><search><creatorcontrib>김종우</creatorcontrib><creatorcontrib>이상호</creatorcontrib><creatorcontrib>김영춘</creatorcontrib><creatorcontrib>양준호</creatorcontrib><creatorcontrib>장인석</creatorcontrib><creatorcontrib>최준영</creatorcontrib><creatorcontrib>Kim, Jong-Woo</creatorcontrib><creatorcontrib>Rhie, Sang-Ho</creatorcontrib><creatorcontrib>Kim, Young-Chun</creatorcontrib><creatorcontrib>Yang, Jun-Ho</creatorcontrib><creatorcontrib>Jang, In-Seok</creatorcontrib><creatorcontrib>Choi, Jun-Young</creatorcontrib><title>기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구</title><title>Taehan Hyungbu Oekwa Hakhoe chi</title><addtitle>The Korean journal of thoracic and cardiovascular surgery</addtitle><description>Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy. 배경: 기계식 인공 심장판막 치환 수술을 받은 환자들에 있어서 장기간의 경구 항응고제 투여는 반드시 필요하다. 그러나 이러한 환자들에 있어서 혈색전증의 발생을 예방하는 동시에 출혈을 방지하기 위한 적절한 항응고제의 용량에 관해서는 아직까지 논의의 소지가 있다. 저자들은 INR (International Normalized Ratios)을 1.5에서 2.5사이에 두는 낮은 강도 항응혈 관리를 적용하여 장기 추적관찰 결과를 분석하였다. 대상 및 방법: 1992년 1월부터 2002년 12월까지 144명의 단일 심장판막 치환 수술을 받은 환자를 대상으로 하였다. 평균연령은 47.4세였고$(15{\sim}72)$, 대동맥판막 치환수술을 받은 환자는 49명, 승모판막 치환수술을 받은 환자는 95명이었다. 이들의 항응고 수치와 임상 결과를 분석하였다. 환자들은 본원 외래로 $1{\sim}2$개월에 한번씩 임상관찰 추적하고 prothrombin time을 측정하여 INR을 낮은 강도 항응혈 목표치인 1.5와 2.5사이에 유지하려 하였다. 결과: 총 144명의 환자에서 추적관찰 기간은 835.3 환자년(평균 $5.9{\pm}3.5$)이었으며 7,706개의 INR측정치가 평가의 대상이었다 승모판막 치환수술군과 대동맥판막 치환수술군 간에 INR 수치는 유의한 차이를 보였다(p<0.01). 모든 환자의 INR측정 수치의 61.9%가 목표 범위 내에 있었다. 심방세동이 있는 환자는 전체의 30.3%였으며 그들의 INR 측정치$(2.16{\pm}0.23)$는 동율동 환자들의 INR 측정치$(2.03{\pm}0.27)$보다 유의하게 높았다(p<0.01). 혈색전증은 9명의 환자에서 보였으며 1.08%/환자년의 발생율을 보였다. 주요 출혈은 2명의 환자에서 발생하였고 발생율은 0.24%/환자년이었다. 환자의 순응도가 좋을수록 합병증 발생율이 유의하게 낮았다(p=0.000). 결론: 단일 대동맥판막 또는 승모판막 치환술 후 항응혈 치료에서 낮은 강도의 INR 목표범위로도 효과적이고 안전한 항응혈 치료가 가능하다는 것을 시사하며 더 효과적인 항응혈 치료를 위해서는 환자의 순응도를 높여야 될 것으로 사료된다.</description><issn>0301-2859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>JDI</sourceid><recordid>eNpjYeA0MDYw1DWyMLXkYOAtLs5MMjA2MzK3MDU15mTIeLVjw6vNLW-65yq8mbvj1eatCm-617yZt_Rtz4TXyzsV3uyc8XbmjDcdCxTezm5ReN207s3cBoVXG6a-7m9ReDt17Zu5E9_O6FB4taXh9bI1b-bOUHizoPHNgqlvWja-mT4BJPx26hyFN9M3vNq6hoeBNS0xpziVF0pzM6i6uYY4e-hmZxaXZMbnpRTnxHs5evsbGRhYGhpamBqYGBkZmBkbE6sOADMKYyI</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>김종우</creator><creator>이상호</creator><creator>김영춘</creator><creator>양준호</creator><creator>장인석</creator><creator>최준영</creator><creator>Kim, Jong-Woo</creator><creator>Rhie, Sang-Ho</creator><creator>Kim, Young-Chun</creator><creator>Yang, Jun-Ho</creator><creator>Jang, In-Seok</creator><creator>Choi, Jun-Young</creator><scope>JDI</scope></search><sort><creationdate>2009</creationdate><title>기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구</title><author>김종우 ; 이상호 ; 김영춘 ; 양준호 ; 장인석 ; 최준영 ; Kim, Jong-Woo ; Rhie, Sang-Ho ; Kim, Young-Chun ; Yang, Jun-Ho ; Jang, In-Seok ; Choi, Jun-Young</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kisti_ndsl_JAKO2009118504220633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>kor</language><creationdate>2009</creationdate><toplevel>online_resources</toplevel><creatorcontrib>김종우</creatorcontrib><creatorcontrib>이상호</creatorcontrib><creatorcontrib>김영춘</creatorcontrib><creatorcontrib>양준호</creatorcontrib><creatorcontrib>장인석</creatorcontrib><creatorcontrib>최준영</creatorcontrib><creatorcontrib>Kim, Jong-Woo</creatorcontrib><creatorcontrib>Rhie, Sang-Ho</creatorcontrib><creatorcontrib>Kim, Young-Chun</creatorcontrib><creatorcontrib>Yang, Jun-Ho</creatorcontrib><creatorcontrib>Jang, In-Seok</creatorcontrib><creatorcontrib>Choi, Jun-Young</creatorcontrib><collection>KoreaScience</collection><jtitle>Taehan Hyungbu Oekwa Hakhoe chi</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>김종우</au><au>이상호</au><au>김영춘</au><au>양준호</au><au>장인석</au><au>최준영</au><au>Kim, Jong-Woo</au><au>Rhie, Sang-Ho</au><au>Kim, Young-Chun</au><au>Yang, Jun-Ho</au><au>Jang, In-Seok</au><au>Choi, Jun-Young</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구</atitle><jtitle>Taehan Hyungbu Oekwa Hakhoe chi</jtitle><addtitle>The Korean journal of thoracic and cardiovascular surgery</addtitle><date>2009</date><risdate>2009</risdate><volume>42</volume><issue>2</issue><spage>193</spage><epage>200</epage><pages>193-200</pages><issn>0301-2859</issn><abstract>Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy. 배경: 기계식 인공 심장판막 치환 수술을 받은 환자들에 있어서 장기간의 경구 항응고제 투여는 반드시 필요하다. 그러나 이러한 환자들에 있어서 혈색전증의 발생을 예방하는 동시에 출혈을 방지하기 위한 적절한 항응고제의 용량에 관해서는 아직까지 논의의 소지가 있다. 저자들은 INR (International Normalized Ratios)을 1.5에서 2.5사이에 두는 낮은 강도 항응혈 관리를 적용하여 장기 추적관찰 결과를 분석하였다. 대상 및 방법: 1992년 1월부터 2002년 12월까지 144명의 단일 심장판막 치환 수술을 받은 환자를 대상으로 하였다. 평균연령은 47.4세였고$(15{\sim}72)$, 대동맥판막 치환수술을 받은 환자는 49명, 승모판막 치환수술을 받은 환자는 95명이었다. 이들의 항응고 수치와 임상 결과를 분석하였다. 환자들은 본원 외래로 $1{\sim}2$개월에 한번씩 임상관찰 추적하고 prothrombin time을 측정하여 INR을 낮은 강도 항응혈 목표치인 1.5와 2.5사이에 유지하려 하였다. 결과: 총 144명의 환자에서 추적관찰 기간은 835.3 환자년(평균 $5.9{\pm}3.5$)이었으며 7,706개의 INR측정치가 평가의 대상이었다 승모판막 치환수술군과 대동맥판막 치환수술군 간에 INR 수치는 유의한 차이를 보였다(p<0.01). 모든 환자의 INR측정 수치의 61.9%가 목표 범위 내에 있었다. 심방세동이 있는 환자는 전체의 30.3%였으며 그들의 INR 측정치$(2.16{\pm}0.23)$는 동율동 환자들의 INR 측정치$(2.03{\pm}0.27)$보다 유의하게 높았다(p<0.01). 혈색전증은 9명의 환자에서 보였으며 1.08%/환자년의 발생율을 보였다. 주요 출혈은 2명의 환자에서 발생하였고 발생율은 0.24%/환자년이었다. 환자의 순응도가 좋을수록 합병증 발생율이 유의하게 낮았다(p=0.000). 결론: 단일 대동맥판막 또는 승모판막 치환술 후 항응혈 치료에서 낮은 강도의 INR 목표범위로도 효과적이고 안전한 항응혈 치료가 가능하다는 것을 시사하며 더 효과적인 항응혈 치료를 위해서는 환자의 순응도를 높여야 될 것으로 사료된다.</abstract><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0301-2859 |
| ispartof | Taehan Hyungbu Oekwa Hakhoe chi, 2009, Vol.42 (2), p.193-200 |
| issn | 0301-2859 |
| language | kor |
| recordid | cdi_kisti_ndsl_JAKO200911850422063 |
| source | KoreaMed Open Access; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| title | 기계식 인공 심장판막 치환술 후 낮은 강도 항응혈 관리의 적정성에 관한 연구 |
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