| ObjectivePlatelet aggregation is one of the most important part of the platelet function, and plays a key role in thrombosis. Efficient detection of platelet aggregation has important clinical significance. Heart valve replacement is an effect way to cure cardiac valvular disease, but the patients after heart valve replacement need life-long anticoagulation. There are still thrombosis complications while using warfarin anticoagulation through monitoring PT and INR in the ideal range. At present, some study showed the platelet was activated in some patients afer heart valve replacement, and some study confirmed that the possibility of thrombosis was higher in part of these patients than in the others. It is a high-risk period of thrombosis in the early postoperative period. The purpose of this study was to observe the change of the platelet aggregation in patients after mitral valve replacement, and we explored the possibility of the adjunct antiplatelet therapy.MethodsThere were 90 patients who underwent cardiac surgery in our hospital including 39 males, 51 females, and the average age of the patients is (26±8.1). The patients were divided into three groups:congenital heart disease(n=30);mitral valve replacement with sinus rhythm(30);mitral valve replacement with atrial fibrillation(n=30). All the prostheses are bileaflet mechanical valves. Blood was sampled at the following time points: on the day before surgery, on the second, fourth, sixth postoperative day and on the day after one month. The platelet aggregation were measured with stimulation by ADP (5, 10μmol/L) and collagen(2μg/ml). A commercial ELISA was used to measure the levels ofβ-TG and PF4 in the plasma.Results①The platelet aggregation in congenital heart disease group showed no statistically significant difference (P>0.05). ②The platelet aggregation in patients with sinus rhythm decreased on the second postoperative day and significantly increased on the fourth postoperative day (P<0.05), and the results of ADP (5 umol/L, 10 umol/L) are (13.56±2.86) ? and (16.73±2.06) ?.③The platelet aggregation in patients with atrial fibrillation decreased on the second postoperative day and significantly increased on the fourth postoperative day (P<0.05), and the result of ADP (5 umol/L, 10 umol/L) and collagen (2 ug/ML) is (14.56±2.32) ?, (17.86±2.43) ? and (21.60±2.60) ?.④The platelet aggregation in patients with atrial fibrillation is higher than that in congenital heart disease group on the day before surgery, and the result of ADP (10 umol/L) and collagen (2 ug/ML) is (15.66±1.72) ?, and (20.36±2.32) ? and (21.60±2.60) ?.⑤The platelet aggregation in patients with atrial fibrillation and sinus rhythm is higher than that in congenital heart disease group on the fourth postoperative day (P<0.05), but the result of collagen (2 ug/ML) in patients with sinus rhythm is (19.66±2.50) ? (P>0.05).⑥The platelet aggregation in patients with atrial fibrillation is higher than that with sinus rhythm on the fourth postoperative day (P<0.05).⑦The platelet aggregation in patients with atrial fibrillation is higher than that in congenital heart disease group and patients with sinus rhythm on the day after one month (P<0.05), but the result of ADP (10 umol/L) in patients with sinus rhythm is (16.20±1.98) ?, (P>0.05).⑧Levels ofβ-TG and PF4 changed significantly on the second postoperative day and on the fourth postoperative day the level ofβ-TG is higher than it before operations.Conclusion⑴The platelet aggregation in all patients decreased after operations and then increased on the fourth postoperative day in congenital heart disease group, mitral valve replacement with sinus rhythm group and mitral valve replacement with atrial fibrillation group.⑵The platelet aggregation in congenital heart disease group showed no statistically significant difference.⑶The platelet aggregation decreased on the second postoperative day and significantly increased on the fourth postoperative day in mitral valve replacement groups compared with congenital heart disease group in corresponding time period and the same group before operations.⑷The platelet aggregation in patients with atrial fibrillation is higher than the congenital heart disease group before operations and the platelet aggregation on the fourth postoperative day is higher than that in patients with sinus rhythm in the same period. On the day after one month the platelet aggregation in patients with atrial fibrillation is higher than the congenital heart disease group and patients with sinus rhythm.⑸Levels ofβ-TG and PF4 changed with large individual differences on the second postoperative day and on the fourth postoperative day the level ofβ-TG is higher than it before operations. All of above proved the increasing of platelet aggregation on the fourth postoperative day as circumstantial evidence.The platelet aggregation showed significant change in patients with mitral valve replacement during postoperative period, especially during the first postoperative week. These patients should be pay more attention to monitor the platelet aggregation and to prevent them from the complication of tromboembolism.
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