目的 采用凝血酶原时间的国际标准化比值(international normalized ratio,INR) 1.60～ 2.20为目标及以周为单位进行华法林剂量调整的抗凝治疗策略,观察机械瓣置换术后稳定期(＞6个月)患者的抗凝效果以及安全性.方法 纳入2011年7月至2016年7月四川大学华西医院和自贡市第四人民医院胸心外科门诊连续收集的2 393例行机械瓣膜置换术≥6个月的患者,其中女1 690例(70.62％)、男703例(29.38％),中位年龄47(14～ 80)岁.术后随访6～61个月.采用1.60 ～ 2.20为目标INR及以周为单位进行华法林剂量调整的抗凝治疗策略.记录这些患者抗凝相关事件(血栓形成、栓塞及出血),并应用治疗范围时间(TTR)及治疗范围时间分数(FTTR)评价抗凝治疗的效果.结果 本研究共记录患者INR检测标本26 521份,检测的INR值范围为0.90 ～ 8.39 (1.82±0.45),为达到目标和可接受的INR值患者每周所需华法林剂量为1.75 ～ 61.25 (21.72±7.39) mg.患者总抗凝观察时间为2 441 060.0d,在目标INR范围及可接受INR的TTR分别为59.38％(1 449 514.0 d/2 441 060.0d)和73.57％(1 795 971.0 d/2 441 060.0d);目标INR及可接受INR范围的FTTR分别为50.71％(13450次/26 521次)和65.25％(17 305次/26 521次);在随访期内,纳入的2 393例患者中发生抗凝相关并发症包括:脑梗死21例(18例完全恢复,3例留有肢体活动障碍),脑溢血4例(1例死亡,3例完全恢复),严重消化道出血3例(完全恢复)及子宫出血1例(手术切除子宫).结论 机械瓣置换术后稳定期采用目标INR 1.60 ～ 2.20并以周为单位进行华法林剂量调整的抗凝治疗策略是合理及安全的.“,”Objective To evaluate the long-term anticoagulation outcomes of target international normalized ratio (INR) 1.60 to 2.20 and weekly dosage adjustment of warfarin in patients after mechanical heart valve replacement.Methods Outpatients after mechanical heart valve replacement at least 6 months were registered continually from July 2011 to July 2016 in department of cardiothoracic surgery at Zigong No.4 People's Hospital and West China Hospital.There were 1 690 females (70.62％) and 703 males (29.38％) with a median age of 47 years,ranging from 14 to 80 years.All patients were followed up for 6-61 months.Target INR was 1.60 to 2.20 and warfarin dosage were adjusted weekly.Unexpected bleeding,thrombogenesis and thromboembolism,time in therapeutic range (TTR) and fraction of TTR (FTTR) were recorded and calculated to evaluate the outcome of anticoagulation management.Results A total of 2 393 patients with 26 521 INR values were included for data analysis.INR values varied from 0.90-8.39 (1.82±0.45) and required weekly doses of warfarin were 1.75-61.25 (21.72±7.39) mg.TTR of target INR and acceptable INR was 59.38％ (1 449 514.0 days/2 441 060.0 days) and 73.57％ (1 795 971.0 days/2 441 060.0 days),respectively.FTTR of target INR and acceptable INR were 50.71％ (13 450 times/26 521 times),65.25％ (17 305 times/26 521 times).During the follow-up,anticoagulation-related complications included:cerebral infarction in 21 patients (complete recovery in 18 patients,physical activity disorder in 3 patients),cerebral hemorrhage in 4 patients (death in 1 patient,complete recovery in 3 patients),severe gastrointestinal bleeding in 3 patients (completely recovered) and uterine bleeding in 1 patient (surgical removal of the uterus).Conclusion Target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement is reasonable and safe.