妊娠相关性静脉血栓栓塞症的抗凝及滤器置入治疗的研究进展

Research Progress of Anti-coagulation Therapy and Filter Placement for Pregnancy associated Venous Thromboembolism

妊娠期肺栓塞和深静脉血栓形成合称为妊娠期静脉血栓栓塞症(PA-VTE)。妊娠期女性由于存在高凝状态、静脉淤滞、血管损伤等特殊的生理变化,VTE发生风险增高。对于怀疑PA-VTE的孕产妇,除非存在明确的抗凝禁忌,首先抗凝治疗。低分子肝素不通过胎盘,且无哺乳禁忌,是妊娠及产褥期VTE患者抗凝治疗的最佳选择,但是对于有高出血风险、肾功能不全,37周后并发VTE的孕妇,建议选择普通肝素。因此,需制订个体化抗凝治疗方案。因产前停用抗凝药物及分娩时因静脉系统快速减压导致血流动力学发生改变,可能造成栓子脱落,增加妊娠晚期及产褥期发生肺栓塞的风险,置入滤器能有效预防肺栓塞的发生。

Pregnancy associated venous thromboembolism（ PA-VTE） is constituted by pulmonary thromboembolism and deep venous thrombosis during pregnancy. Blood hypercoagulable state,along with venous stasis and vascular damage during pregnancy and puerperium contribute to a high incidence of VTE. In clinically suspected PA-VTE,anti-coagulation therapy should be commenced immediately,unless treatment is strongly contra-indicated. Low molecular weight heparin does not pass through the placenta and is safe during breastfeeding,therefore it is the best choice for pregnancy and puerperium. But for some cases,such as high risk of bleeding,renal inadequacy and acute VTE after 37 weeks during pregnancy,unfractionated heparin will be the first choice. Therefore,individualized anticoagulant therapy should be developed. Stopping anti-coagulantion near labor and changes of hemodynamic system because of rapid decompression of venous system at delivery,may result in embolus shedding,and increase the risk of pulmonary embolism during late pregnancy and postpartum stage. Placing inferior vena cava filters can effectively prevent pulmonary embolism.