机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗对妊娠结局影响的Meta分析

Meta-analyses of Pregnancy Outcomes in Women with Mechanical Heart Valves Treated by Different Anticoagulant Regimens

目的比较机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗对妊娠结局的影响。方法采用Cochrane系统评价方法,检索MEDLINE(1980～2007)、EMbase(1984～2004)、CBM(1980～2007)、CNK(I1994～2007)等电子资料库,由2名评价者共同评价纳入研究质量,对同质研究进行Meta分析。结果共纳入7个研究、469例患者、629孕次;其中5篇为回顾性研究,2篇为前瞻性研究。机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗与法华林治疗比较,母体不良结局发生率差异无统计学意义;胎儿不良结局发生率差异也无统计学意义。结论目前的研究证据表明,机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗并不能减少胎儿不良结局发生率。整个孕期口服小剂量华法林抗凝治疗,生产前停华法林改为肝素是可行的方案,但需与患者充分沟通。

Objective To assess different anticoagulant regimens in pregnant women with mechanical heart valves： taking oral warfarin throughout the pregnancy, or heparin in the 1st trimester and oral warfarin for the other trimesters. The main outcome measures were major maternal complications and perinatal outcomes. Methods The MEDLINE, EMbase, CBM and CNKI were searched. The quality of the included studies was evaluated and data were extracted by two reviewers independently. Meta-analyses were performed on the results of homogeneous studies. Result Seven studies involving 629 pregnancies in 469 patients met the inclusion criteria for this review, all of which were retrospective surveys. The comparison between the administration of heparin in the 1st trimester plus oral warfarin for the other trimesters and warfarin throughout the pregnancy showed that, there are not significant different in the incidence of major maternal complications and the incidence of adverse perinatal outcomes. Conclusion Compared with the administration of warfarin throughout the pregnancy, the administration of heparin in the 1st trimester and oral warfarin for the other trimesters might increase the incidence of major maternal complications, but with a similar incidence of adverse perinatal outcomes.