目的：研究心脏瓣膜置换术后患者质子泵抑制剂（PPIs）对华法林抗凝初期的有效性及安全性的影响。方法：收集2013年1月至2014年12月在南京鼓楼医院行心脏瓣膜置换术后使用华法林联合PPIs的患者294例，根据术后使用PPIs的种类分为奥美拉唑组和泮托拉唑对照组。回顾性分析两组间PT值、INR值及华法林日剂量的差异，根据不良反应发生率及停药率评估PPIs与华法林联用的安全性。结果：两组间的华法林平均日剂量、INR值首次达标时间和住院期间INR的控制情况差异无统计学意义（P>0.05）。服药第1天和7天的INR值、PT值在两组间均无显著性差异（P>0.05）,第4天奥美拉唑组INR 1.84±0.49、PT（21.3±5.7）s，显著高于泮托拉唑组INR 1.71±0.37、PT（19.7±4.4）s，P<0.05。在INR 1.6~2.2亚组中，两组术后第4天的INR值分布存在显著性差异（P<0.05）。在安全性指标方面，奥美拉唑组的华法林停药率为（46.1%），显著高于泮托拉唑组（25.25%），INR>3的次数、栓塞率和出血率在两组间的差异均无统计学意义（P>0.05）。结论：心脏瓣膜置换术后的患者，在服用华法林抗凝的初期，奥美拉唑增强了华法林的抗凝效果，且影响华法林使用的安全性（如增加华法林的停药率），两药联用时应当严密监测INR值，保证抗凝治疗的安全。%Objec tive: To investigate the impact of proton pump inhibitors (PPIs) on the efficacy and safety of initial warfarin anticoagulation response in patients with surgery of heart value replacement. Meth-ods: Data were collected from 294 patients who used PPIs and warfarin concomitantly after heart value re-placement surgery from January 2013 to December 2014 in our hospital. These patients were divided into two groups on PPIs: omeprazole group and pantoprazole group. A retrospective analysis of differences in PT values, INR values and daily warfarin dosage between the two groups was conducted on safety of the com-bination according to incidence of adverse reactions and withdrawal rates. Results: There was no significant difference in the mean daily dose of warfarin, the day for the first time to reach the target INR range and INR controlling situation during hospitalization between the two PPIs groups (P>0.05). Additionally, no dif-ference was observed in the value of PT-INR on the first and seventh day between the two groups (P>0.05), while significant differences occurred between the omeprazole group INR 1.84 ±0.49, PT (21.3 ±5.7)s and the pantoprazole group INR 1.71±0.37, PT (19.7±4.4)s, P<0.05 after the fourth day of surgery. In the INR 1.6-2.2 subgroup, INR value distribution was significantly different between the two groups at the postoperative day 4 (P<0.05). On the safety aspects, warfarin withdrawal rate of the omeprazole group (46.1%) was significantly higher than that of the pantoprazole group (25.25%), however, there was no sig-nificant difference in times of INR>3, rates of embolization and bleeding between the two groups (P>0.05). Conclusion: Omeprazole enhances the effects of warfarin in the period of warfarin initial anticoagulation in patients with heart valve replacement, and it has an effect on safety of warfarin use (such as: the increased warfarin withdrawal rates). Therefore, we should closely monitor INR values when warfarin is combining with omeprazole to ensure the safety of anticoagulant therapy.
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