换瓣后吃华法林还是利伐沙班？

Valve replacement generally refers to heart valve replacement surgery, that is, heart valve replacement surgery. After the operation, patients can take warfarin (warfarin sodium tablets) or rivaroxaban, both of which can have an anticoagulant effect and prevent the formation and development of thrombus, which is beneficial to postoperative recovery and has better effects.

There is not much data on the relative effectiveness of rivaroxaban compared with warfarin in reducing the risk of stroke and systemic embolism under conditions well controlled by warfarin therapy.

About warfarin

Warfarin is a medium-effective dicoumarin anticoagulant. It can compete with vitamin K to inhibit the synthesis of coagulation factors in liver cells. It can also reduce platelet aggregation caused by thrombin. It has anticoagulant and antiplatelet aggregation functions and can prevent the formation and development of thrombus. It is suitable for patients who require long-term continuous anticoagulation, such as thromboembolic diseases, venous thrombosis after surgery or trauma, and can also be used as an auxiliary drug for myocardial infarction.

What is rivaroxaban

It is a bioavailable oral factor

Rivaroxaban

In a multicenter, parallel-group, open-label, randomized study, 500 children with documented acute venous thromboembolism and who had begun heparinizing therapy were assigned to receive a weight-adjusted 20 mg equivalent dose of rivaroxaban or a standard anticoagulant (heparin or a switch to a vitamin K antagonist).

After a median follow-up of 91 days for children during the 3-month study treatment period (n = 463) and 31 days for children during the 1-month study treatment period (n = 37), symptomatic recurrent venous thromboembolism occurred in 1% of the 335 children who received rivaroxaban and 3% who received standard anticoagulants.

Rivaroxaban improved thrombus burden compared with standard anticoagulants, and the absolute and relative efficacy and safety of rivaroxaban compared with standard anticoagulant therapy were similar to those assessed in adult studies of rivaroxaban.

In children with acute venous thromboembolism, treatment with rivaroxaban resulted in a similar low risk of recurrence and reduced thrombotic burden compared with standard anticoagulants without an increase in bleeding.

Rivaroxaban is 10 mg and can be taken with food or alone. Rivaroxaban 15 mg or 20 mg needs to be taken with food. After missing a dose, the patient should take rivaroxaban immediately and continue taking it the next day. It is recommended to consult a doctor for the specific dosage and course of treatment.

References:

Male C, Lensing AWA, Palumbo JS, Kumar R, Nurmeev I, Hege K, Bonnet D, Connor P, Hooimeijer HL, Torres M, Chan AKC, Kenet G, Holzhauer S, Santamaría A, Amedro P, Chalmers E, Simioni P, Bhat RV, Yee DL, Lvova O, Beyer-Westendorf J, Biss TT, Martinelli I, Saracco P, Peters M, Kállay K, Gauger CA, Massicotte MP, Young G, Pap AF, Majumder M, Smith WT, Heubach JF, Berkowitz SD, Thelen K, Kubitza D, Crowther M, Prins MH, Monagle P; EINSTEIN-Jr Phase 3 Investigators. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomized, controlled, phase 3 trial. Lancet Haematol. 2020 Jan;7(1):e18-e27. doi: 10.1016/S2352-3026(19)30219-4. Epub 2019 Nov 5. PMID: 31699660.

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