SURGERY FOR THE PATIENTS OF ANTICOAGULANTS FOLLOWING PROSTHETIC VALVE REPLACEMENT

Based on our experience with eight patients operated on during anticoagulant regimen following prosthetic vulve replacement, pre- and postoperative anticoagulant regimen which should be more appropriate for such patients was studied. The durations between the vulve replacement and operations ranged from 9 months to 8 years and 11 months. Operations that they underwent included S4 subsegmentectomy in one case, total gastrectomy in one case, cholecystectomy in 2 cases, hernioplasty of the abdominal wall in one case, and inguinal hernioplasty in 2 cases. Warfarin was reduced in doses gradually before operations and heparin therapy was instituted for the prevention of thrombo embolism with the prothrombin activity recovered to 40% of the normal level by thrombotest, and operations were performed with recoved to 50% by PT. Heparin therapy was maintained by continuous intravenous infusion to produce ACT of 130 to 160 seconds. There was episode of hemorrhage required blood transfusion, in a patient receiving heparin ther apy, but there was no thromboembolism. We believe that our method which minimizes the nonanticoagulated time appears safe and effective for patients with prosthetic heart valves who require noncardiac operations.