人工心脏瓣膜置换术后妊娠期抗凝药物的安全应用  

Safe use of anticoagulants with implantation of prosthetic valve during pregnancy

作　　者：丁征 王莹 陈星伟 莎兰 郑英丽 

机构地区：[1]中国医学科学阜外医院药剂科,北京100037

出　　处：《药物不良反应杂志》2017年第5期364-367,共4页Adverse Drug Reactions Journal

摘　　要：人工瓣膜置换术后妊娠所面临的一个特殊问题是抗凝治疗.口服抗凝药物用于瓣膜病抗栓治疗疗效确切,但该类药物可透过胎盘导致胎儿畸形,尤其是华法林日剂量过大或在妊娠期6~12周使用该药时致畸风险更大;普通肝素和低分子肝素不透过胎盘,但用于瓣膜病的抗栓作用不如华法林,这些矛盾使得妊娠期的抗凝治疗更加复杂.基于循证医学证据和指南推荐,对于人工机械瓣膜置换术后妊娠者,应根据妊娠不同时期采取个体化治疗,最大程度减少抗凝治疗对孕妇和胎儿安全的影响.Specific problems mainly related to anticoagulant therapy are present in women with prosthetic heart valve during pregnancy. Oral anticoagulants（OAC）indicated for valvular heart disease are highly efficacious for antithrombotic purposes,while OAC could cross the placenta increasing the risk of embryopathy,especially when the required warfarin dose was high daily or when warfarin is used in weeks 6-12 during pregnancy. Unfractionated heparins and low molecular weight heparin do not cross the placenta but they are not as effective as warfarin. The contradictions complicate the use of the anticoagulants. According to evidence-based medicine and guidelines,we should take corresponding personalized measures according to stages of pregnancy to minimize the risk of thrombosis and bleeding and the risk on maternal and fetal sides.

关 键 词：人工心脏瓣膜 妊娠 抗凝药 

分 类 号：R714.252[医药卫生—妇产科学]