心脏机械瓣膜置换术后妊娠1 2例抗凝治疗的临床观察

目的探讨心脏机械瓣膜置换术后妊娠妇女抗凝治疗的方法,以及抗凝药物对孕妇和胎儿的影响.方法随访12例心脏机械瓣膜置换术后妇女妊娠、分娩期抗凝治疗情况.结果12例患者整个妊娠期均采用口服抗凝药治疗(除1例曾停服半月外).国产华法林平均用量为(3.14±0.28)mg/d(6例),进口华法林平均用量为(2.71±1.24)mg/d(4例),国产新抗凝(3.14±1.08)mg/d(2例).所有孕妇均无严重出血及栓塞等并发症发生,8例次有一般性出血现象;足月妊娠10例,早产2例,新生儿均无畸形发生,仅1例新生儿出生体重低于正常(2100g).结论心脏机械瓣膜置换术后妇女妊娠期间,单一服用较小剂量的华法林(＜5mg/d)行抗凝治疗对孕妇安全、方便,且无胎儿畸形发生.

The follow-up of 12 pregnant women with anticoagulation therapy after mechanical heart valve replacement

OBJECTIVE: The article discusses the effect of warfarin on pregnant women and their fetus, and the methods of anticoagulation therapy during pregnancy. METHODS: The pregnancy, delivery, and anticoagulation therapy of 12 pregnant women with mechanical heart valve replacement were followed-up. RESULTS: All the patients received oral anticoagulant therapy during pregnancy. The mean dose of imported warfarin was (2.71 +/- 1.24) mg/d (4 cases); domestic warfarin, (3.14 +/- 0.28) mg/d (6 cases); domestic acenocumarol tablet (3.14 +/- 1.08) mg/d (2 cases). No thromboembolism and major hemorrhage occurred. A total of 8 person/times had minor bleeding. Ten patients had term delivery, 2 had premature birth, No abnormal fetus was observed. Only 1 newborn had low birth weight (2,100 g). CONCLUSION: The anticoagulation therapy with low dosage of warfarin (< 5 mg/d) is safe and convenient for the mothers during pregnancy following mechanical heart valve replacement and has low fetus abnormal rate.