心脏机械瓣膜置换术后妊娠期不同抗凝治疗策略比较

Comparison of different anticoagulant therapy strategies in pregnancy after mechanical heart valve replacement surgery

妊娠期的高凝状态,使心脏机械瓣膜置换术后的孕妇具有较高的血栓栓塞风险,有效的抗凝治疗至关重要。华法林能有效预防瓣膜血栓形成,对母体最安全,但可引起胚胎病。普通肝素和低分子肝素对胎儿的安全性较高,但抗栓作用较弱,增加母体瓣膜血栓形成风险。目前对于新型口服抗凝药用于心脏机械瓣膜置换术后患者的研究较少,现有证据不建议用于此类人群。随着研究的不断深入,对于使用低剂量华法林(≤5 mg/d)即可达到目标国际标准化比值的高栓塞风险患者,可考虑整个妊娠期使用华法林;如使用高剂量华法林(>5 mg/d)方可达到目标国际标准化比值,可在妊娠早期使用调整剂量的低分子肝素,妊娠中晚期换用华法林。

The hypercoagulable state during pregnancy increases the risk of thromboembolism in pregnant women after mechanical heart valve replacement surgery,and effective anticoagulant therapy is very important.Warfarin can effectively prevent valve thrombosis,which is the safest for the mother,but can cause embryopathy.Unfractionated heparin and low molecular weight heparin are safe for the fetus,but have weak antithrombotic effects and increase the risk of maternal valve thrombosis.At present,there are few studies on the use of new oral anticoagulants in patients after mechanical heart valve replacement surgery,and the existing evidence is not recommended for such populations.With the deepening of research,for patients with high embolism risk who can reach the target international normalized ratio by using low dose Warfarin(less than or equal to 5 mg/d),Warfarin may be considered throughout pregnancy.If high dose Warfarin(greater than 5 mg/d)is used to achieve the target international normalized ratio,low molecular weight heparin with adjusted dosage can be used in the early pregnancy,and Warfarin can be used in the middle and late pregnancy.