妊娠期机械心脏瓣膜置换非华法林抗凝患者出现血栓卡瓣2例并文献复习  

Mechanical heart valve thrombosis during pregnancy under non-warfarin anticoagulation therapy:Two-case report and literature review

作　　者：黄健[1] 刘一涵 HUANG Jian;LIU Yihan(Department of Gynecology and Obstetrics,Second Xiangya Hospital,Central South University,Changsha 410011;Xiangya School of Medicine,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅二医院妇产科,长沙410011 [2]中南大学湘雅医学院,长沙410013

出　　处：《中南大学学报（医学版）》2021年第2期207-211,共5页Journal of Central South University ：Medical Science

摘　　要：有二尖瓣机械瓣置换史的患者必须规律服用抗凝药物以抵抗血栓风险,华法林等抗凝药物因存在致畸风险,故孕妇在妊娠过程中必须更换抗凝方案。欧洲心血管学会临床指南对妊娠期间抗凝治疗给出了明确的建议。笔者报告2例患者:1例妊娠期全程用肝素抗凝,导致妊娠晚期血栓卡瓣;1例遵循指南,在早孕期使用肝素替代抗凝治疗亦出现血栓卡瓣。针对指南和个体化用药之间的平衡,笔者提出如下建议:换瓣患者妊娠期的抗凝必须在严密监测凝血功能的情况下采取个体化的方案;当这类孕妇出现急性心力衰竭症状时,需要排除机械瓣卡瓣的情况,并积极行手术处理。Anticoagulation drugs should be used for patients with mechanical heart valve(MHV)in case of potential risk of thrombosis.Pregnant women with MHV have to change therapies due to teratogenic effect of some anti-coagulation drugs.European Society of Cardiology clinical guidelines for the management of cardiovascular diseases during pregnancy gives specific suggestions for anticoagulation therapy.We have treated 2 patients with mechanical heart valve thrombosis(MVT)during pregnancy:One received low molecular weight heparin(LMWH)throughout the pregnancy and developed MVT at the third trimester of pregnancy;one developed MVT at the first trimester when replacing vitamin K antagonists(VKA)with LMWH.These patients raised secondary reflection on the balance between clinical guideline and personalized medicine.During LMWH therapy,we should dynamically monitor patients’anti-activated factor X(anti-Xa)level to evaluate coagulation function during pregnancy.When a pregnant woman with MHV develops symptoms of acute heart failure,stuck mechanical valve should be paid attention to and surgery should be promptly performed if necessary.

关 键 词：妊娠 机械心脏瓣膜 抗凝治疗 肝素 维生素K拮抗剂 

分 类 号：R714.252[医药卫生—妇产科学]