A STUDY ON THE USEFULNESS OF ANTICOAGULATION THERAPY IN MITRAL STENOSIS AFTER OPEN MITRAL COMMISSUROTOMY

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  • OKAMURA Kenji
    Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba
  • ATSUMI Naotaka
    Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba
  • JIKUYA Tomoaki
    Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba
  • SAKAKIBARA Yuzuru
    Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba
  • MITSUI Toshio
    Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba

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  • 僧帽弁狭窄症直視下交連切開術後の抗凝固療法の有用性に関する研究

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Abstract

Thromboembolism is one of the most serious complications, which affects the patient's morbidity and mortality, after open mitral commissurotomy (OMC) in mitral stenosis. This report aims to clarify whether the anticoagulation therapy could decrease this serious complication or not, by comparing the thromboembolism event free rate, causes of late deaths and cumulative survival rate between 36 patients without (group I) and 28 patients with (group II) anticoagulation therapy. Simultaneously, the risk factors of thromboembolism, that is, with or without anticoagulation therapy, atrial fibrillation, left atrial thrombus, preoperatively complicated thromboembolism and functional class of NYHA, have been ranked by multivariate analysis. Oral antiplatelet drugs in 68% and warfarin in 32% of group II patients were used for the anticoagulation therapy.<br> A linearized rate of thromboembolism in group I was 2.7%/py and significantly higher than that of group II in 0.4%.py. The actuarial freedom from thromboembolism in group I was 77±10% and significantly lower than that of group II in 90±9% at 11 years after the operation. The cumulative survival rate at 11 years showed significantly good result of 95±5% in group II comparing with the result of 87±6% in group I. The multivariate analysis showed the msot significant inter-relationship between the anticoagulation therapy and thromboembolism as a risk factor. Thus, the anticoagulation therapy, especially antiplatelet therapy, after OMC, was useful for the prevention of thromboembolism and the improvement of the cumulative survival rate.

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