心脏机械瓣膜置换术后妊娠期两种抗凝方案疗效Meta分析

目的 评价全程使用维生素K拮抗剂（VKA）的抗凝方案与妊娠早期短程使用低分子肝素/肝素的方案应用于心脏机械瓣膜置换术患者妊娠期的有效性与安全性。方法 通过多种途径检索截止至2013年10月关于两种抗凝方案比较的研究，后进行Meta分析。结果 纳入的10项研究分析结果显示全程使用VKA的抗凝方案较之妊娠早期短程使用低分子肝素/肝素的方案：（1）母体栓塞事件发生率明显降低（OR：0.33,95%CI：0.19~0.57,P<0.0001）。（2）胎儿流失发生率增加56%（OR：1.56,95%CI：1.11~2.20,P=0.0106）。（3）胎儿早产、低出生体重儿发生率稍增加。结论 心脏机械瓣膜置换术孕妇抗凝方案应根据栓塞风险、经济情况、治疗依从性等进行选择。

Comparison of two anticoagulant therapy regimens during pregnancy for patients with prosthetic mechanical heart valve:a Meta-analysis.

Abstract：Objective To compare the effects of anticoagulant regimen of oral anticoagulant (VKA) throughout pregnancy compared with that of low molecular weight heparin/unfractionated heparin in the first trimester and oral anticoagulant thereafter for patients with prosthetic mechanical heart valve.Methods Relevant researches reported before October 2013 were identified in a number of electronic databases and analyzed with software RevMan 5.0 and R2.13.0.Results Ten studies of anticoagulant regimen were identified. Pooled estimates revealed significant reductions in maternal major thromboembolic events (odds ratio OR: 0.33,95%CI: 0.19~0.57), increase in fatal wastege (OR: 1.56,95%CI: 1.11~2.20) with oral anticoagulant throughout pregnancy,as comparing with low molecular weight heparin/unfractionated heparin in the first trimester and oral anticoagulant thereafter.The rate of preterm infants and low-birthweight infants infants increased a little.Conclusion We advocate an individualized anticoagulation strategy that takes into account thromboembolic risk, economic condition and therapeutic compliance for patients with prothetic mechanical heart valve.