低分子肝素防治自然流产中国专家共识

Chinese experts consensus on prevention and treatment of spontaneous abortion with low molecular weight heparin

低分子肝素(LMWH)是一类高效、相对安全的糖类抗凝剂。为了进一步指导和规范LMWH在自然流产防治中的应用,妇产科学、生殖医学、风湿免疫病学以及药理学等领域的相关专家根据国内外的研究进展,结合我国的实际情况,针对LMWH防治自然流产的适应证、剂量、疗程、监测等方面进行了充分讨论,并制定了该共识。共识指出LMWH用于防治自然流产的适应证主要是抗磷脂综合征(APS)、易栓症(PTS)、自身免疫性疾病(AID)等。依据病情,LMWH使用剂量有预防剂量和治疗剂量。对于不明原因的反复自然流产(URSA)、反复生化妊娠(RBP)和反复种植失败(RPF)患者使用LMWH能否改善妊娠结局尚缺乏依据,尚无足够的临床证据显示增加LMWH剂量能增加血β-人绒毛膜促性腺激素(hCG)水平。对于合并高血压、糖尿病、慢性肾脏疾病等病程较长、有可能存在血管内皮损伤的反复自然流产(RSA)患者,可以适当应用LMWH,但疗效有待进一步临床验证。临床上应避免超适应证和超大剂量使用。

Low molecular weight heparin（LMWH） is a kind of high efficiency and relatively safety sugar anticoagulants. To further guide and standardize the application of LMWH in the prevention and treatment of natural abortion, this consensus, including the indications, dosage, treatment course, and monitoring of natural abortion in LMWH, was made by experts in the fields of obstetrics and gynecology, reproductive medicine, rheumatology and pharmacology. The consensus points out that the indications of LMWH for the prevention and treatment of natural abortion are mainly antiphospholipid syndrome（APS）, pre-thromobolic state（PTS）, autoimmune disease（AID）, etc. According to the condition, LMWH can be used with preventive dosage and therapeutic dosage. Whether LMWH can improve pregnancy outcome in patients with unexplained recurrent spontaneous abortion（URSA）, repeated biochemical pregnancy（RBP）, and repeated planting failure（RPF） is unproven, and there is no enough clinical evidence to show that LMWH can increase the level of blood β-human chorionic gonadotrophin（h CG）. LMWH can be applied to patients with recurrent spontaneous abortion（RSA） who also have a long course of hypertension, diabetes, chronic kidney diseases and may have vascular endothelial injury, but the efficacy remains to be further verified. Clinically, indications range expansion and super-large dosage should be avoided.