根據 2020 年美國心臟協會／學會 (American College of Cardiology/American Heart Association, ACC/AHA) 指南建議，所有機械性心臟瓣膜 (mechanical heart valves, MHVs) 置換者，都應使用 vitamin K antagonists (VKAs) 作為抗凝血處置用 藥，其中最常見的 VKAs 是 warfarin。對於僧帽瓣 MHVs 置換後族群，該指南建議 warfarin 之國際標準化比值 (international normalized ratio) 應達 3.0。Warfarin 容易 受到藥物和食物間交互作用影響。而新一代口服抗凝血劑 - 非維生素 K 拮抗口服抗 凝血劑 (non-vitamin K antagonist oral anticoagulant, NOACs) 交互作用較少且不需定 期監測。不過 NOACs 並沒有明確客觀的評估指標可供即時查驗，這對機械性僧帽瓣 置換後族群的血栓風險形成威脅。關於僧帽瓣 MHVs 置換後使用 NOACs 的適當性， 2020 年 ACC/AHA 指南已明確指示，對 MHVs 置換者以 dabigatran 進行抗凝血處置 屬禁忌。此外，由於 anti-Xa direct oral anticoagulants 的適當性尚未獲得評估，因此 不建議僧帽瓣 MHVs 置換者使用，所以 warfarin 仍是這個族群選擇抗凝血劑時的唯一選項。
According to the recommendation of 2020 American College of Cardiology/ American Heart Association (ACC/AHA) guideline, vitamin K antagonists (VKAs) should be used as anticoagulant management in all patients with mechanical heart valves (MHVs), and the most common VKAs is warfarin. For the population after mitral valve MHVs replacement, the guidelines recommend that the international normalized ratio of warfarin should be 3.0. While warfarin is affected by many interactions between drugs and food, a new generation of oral anticoagulants—non-vitamin K antagonist oral anticoagulants (NOACs) have less interaction and do not need to be monitored regularly. However, the NOACs do not have clear and objective assessment indicators for immediate inspection, which poses a threat to the risk of thrombosis to the population after mechanical replacement of the mitral valve. Regarding the appropriateness of using NOACs after mitral valve MHVs replacement, the 2020 ACC/ AHA guidelines have clearly indicated that dabigatran anticoagulant treatment for MHVs replacement is contraindicated. In addition, since the appropriateness of antiXa direct oral anticoagulants has not been evaluated, it is not recommended for mitral valve replacement MHVs. Therefore, warfarin is still the only option for this population.
Summited for publication: 2021.6.1; Accepted for publication: 2021.10.29
