背景:对于需要大剂量华法林的机械心脏瓣膜(MHV)孕妇,最佳的孕早期抗凝治疗仍然具有挑战性。这项多中心前瞻性研究旨在确定妊娠MHV患者的最佳抗凝方案。
方法:所有妇女在孕早期被分配到三种治疗方案之一,包括单用低分子量肝素(LMWH),LMWH+2.5mg华法林的组合,和LMWH+4毫克华法林。主要的产妇结局包括死亡的组合,血栓栓塞,严重出血,并且需要治疗机械瓣膜血栓形成(MVT)。任何胎儿丢失都被确定为主要的胎儿结局。
结果:该研究包括65例MHV女性的78例妊娠。主要产妇结局率为44%,12.5%,3.5%,分别。主要产妇结局的发生率(44vs3.5%,p<0.001),阻塞性MVT(16vs0%,p=0.04),需要治疗的MVT(28vs0%,p=0.003),和脑栓塞(24vs3.4%,与LMWH4mg华法林组相比,单独LMWH组的p=0.041)明显更高。此外,主要产妇结局率(12.5vs44%,p=0.015)和MHV血栓的治疗(4.2vs28%,p=0.049)与单独的LMWH组相比,LMWH2.5mg华法林组明显更低。在单独的LMWH组中,胎儿丢失的发生率为8(32%),8(33.3%)在LMWH+2.5mg华法林组,LMWH+4mg华法林组11例(37.9%)(3组p=0.890)。在任何情况下均未观察到华法林相关胚胎病。
结论:在妊娠早期,LMWH联合低剂量华法林的联合抗凝策略可能导致MHV患者的母体并发症较少,胎儿结局相当。
结论:低分子量肝素(LMWH)被认为对胎儿更安全,然而,怀疑它对母亲的保护作用较弱。为了解决这个困境,作者提出了一种用于有人工瓣膜的孕妇的新型抗凝策略.该研究包括65名妇女的78例怀孕[中位年龄32(27-35)岁]。LMWH和减少剂量的华法林的组合与患有机械心脏瓣膜的怀孕患者的血栓相关并发症的低发生率相关。
Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin. This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs.
All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH + 2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT). Any fetal loss was determined as primary fetal outcome.
The study included 78 pregnancies in 65 women with MHVs. Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively. The rates of primary maternal outcome (44 vs 3.5%, P < .001), obstructive MVT (16 vs 0%, P = .04), MVT requiring treatment (28 vs 0%, P = .003), and cerebral embolism (24 vs 3.4%, P = .041) were found to be significantly higher in lone LMWH group compared to LMWH + 4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, P = .015) and treatment for MHV thrombus (4.2 vs 28%, P = .049) were significantly lower in LMWH + 2.5 mg warfarin group compared to lone LMWH group. The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH + 2.5 mg warfarin group, and 11 (37.9%) in LMWH + 4 mg warfarin group (P = .890 for 3-group).Warfarin related-embryopathy was not observed in any case.
The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs.
Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women (median age 32 [27-35] years) were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.