心脏机械瓣膜置换术后妊娠12例抗凝治疗的临床观察

The follow-up of 12 pregnant women with anticoagulation therapy after mechanical heart valve replacement

目的 探讨心脏机械瓣膜置换术后妊娠妇女抗凝治疗的方法 ,以及抗凝药物对孕妇和胎儿的影响。方法 随访 12例心脏机械瓣膜置换术后妇女妊娠、分娩期抗凝治疗情况。结果 12例患者整个妊娠期均采用口服抗凝药治疗 (除 1例曾停服半月外 )。国产华法林平均用量为 ( 3 14±0 2 8)mg d( 6例 ) ,进口华法林平均用量为 ( 2 71± 1 2 4 )mg d( 4例 ) ,国产新抗凝 ( 3 14± 1 0 8)mg d( 2例 )。所有孕妇均无严重出血及栓塞等并发症发生 ,8例次有一般性出血现象 ;足月妊娠 10例 ,早产 2例 ,新生儿均无畸形发生 ,仅 1例新生儿出生体重低于正常 ( 2 10 0g)。结论 心脏机械瓣膜置换术后妇女妊娠期间 ,单一服用较小剂量的华法林 ( <5mg d)行抗凝治疗对孕妇安全、方便 ,且无胎儿畸形发生。

Objective The article discusses the effect of warfarin on pregnant women and their fetus, and the methods of anticoagulation therapy during pregnancy Methods The pregnancy, delivery, and anticoagulation therapy of 12 pregnant women with mechanical heart valve replacement were followed up Results All the patients received oral anticoagulant therapy during pregnancy The mean dose of imported warfarin was (2 71±1 24) mg/d (4 cases); domestic warfarin, (3 14±0 28) mg/d (6 cases); domestic acenocumarol tablet (3 14±1 08) mg/d (2 cases) No thromboembolism and major hemorrhage occurred A total of 8 person/times had minor bleeding Ten patients had term delivery, 2 had premature birth, No abnormal fetus was observed Only1 newborn had low birth weight (2 100 g) Conclusion The anticoagulation therapy with low dosage of warfarin (<5 mg/d) is safe and convenient for the mothers during pregnancy following mechanical heart valve replacement and has low fetus abnormal rate