机械心脏瓣膜置换术后妊娠的低强度抗凝策略

The impact of the low intensity of oral anticoagulation therapy for pregnant women with mechanical heart valve prostheses

目的：探讨适合我国机械心脏瓣膜置换术后妊娠妇女特点的抗凝治疗方案。方法：对19例置换机械心脏瓣膜后需长期进行抗凝治疗的妊娠妇女，采用妊娠期全程口服小剂量华法林低强度抗凝策略（INR1．5～2．2），调整合适的华法林剂量。其中2例曾于妊娠早期和晚期短时应用肝素抗凝。分娩前后调整抗凝方案。观察妊娠期间血栓栓塞及出血并发症发生率、分娩出血情况及小剂量华法林对胎儿的影响。结果：本组19例妊娠22例次，妊娠期间未发生血栓栓塞事件；发生与抗凝有关的轻度皮肤粘膜出血4例，为疏于抗凝监测所致。经剖宫产或阴道分娩18例，人工流产1例，自然流产3例次，均未发生产后出血。胎儿娩出时均存活良好，无畸形。稳定的INR为1．88±0．29，口服华法林维持剂量为（3．05±0．92）mg／d（芬兰剂型）和（3．28±1．02）mg／d（齐鲁制药剂型）。结论：国人机械心脏瓣膜置换术后妊娠期全程口服小剂量华法林低强度抗凝治疗（INR1．5～2．2）是方便安全的。在此剂量下并不增加胎儿畸形的风险。

Objective：To define optimal intensity of oral anticoagnlation therapy for chinese pregnant women with mechanical heart valve prostheses. Methods：Nineteen pregnant women with mechanical heart valve prostheses received low intensity of oral anticoagulation therapy with warfarin in the whole pregnant period. The value of international normal ratio （INR） was limited to 1.5 -2.2. Two cases received subcutaneous heparin within a short time in early and late pregnant stage. Results：During the pregnant period of all patients, four cases of slight hemorrhage occurred because of inapproprote control of INR and no thromboembolism complications occurred. All the eighteen neonates were normal, without malformation after delivery. The maintainable level of INR was 1.88 ± 0. 29. The maintainable dose of warfarin was （3.05 ± 0. 92 ） mg/d （ Orion corporation, Finland） or （ 3.28 ± 1.02 ） mg/d （ Qilu Pharmaceuical LTD, China）. Conclusion： In Chinese pregnant women with mechanical heart valve prostheses, a low intensity level of oral anticoagnlation therapy with warfarin （ INR 1.5 - 2.2 ） is convenient and safe,with no increased risk of fetal malformation.