Abildgaard U, Gjestvang F T, Lossius P, Hodne E
Medisinsk klinikk Aker sykehus, Oslo.
Tidsskr Nor Laegeforen. 1999 Nov 30;119(29):4319-20.
Women with a prosthetic heart valve who wish to bear a child face a difficult choice. Continued medication with warfarin during pregnancy will offer her a reasonable good protection against thrombosis, but carries a considerable risk of teratogenic effects. Subcutaneously administered heparin is an alternative to warfarin. Standard (unfractionated) heparin has not offered sufficient protection against valve thrombosis, which may be a life-threatening complication. We were contacted by a woman who wished to become pregnant and who did not want to use warfarin if this implied a risk for the foetus. We followed a protocol using low molecular weight heparin in rather high doses. The dose was adjusted according to the results of blood test controls, which confirmed increased need for anticoagulation as the pregnancy evolved. Serial eccocardiography excluded valve thrombosis. The woman needed psychological support from her general practitioner. No complications occurred, and she gave birth to a normal child. We describe the various alternatives for anticoagulant treatment in pregnant women with mechanical heart valves. The choice of anticoagulant regimen and their consequences must be thoroughly discussed with the woman.
患有人工心脏瓣膜且希望生育的女性面临艰难抉择。孕期持续使用华法林能为她提供较好的预防血栓形成的保护，但存在相当大的致畸风险。皮下注射肝素是华法林的替代药物。标准（未分级）肝素对瓣膜血栓形成的预防作用不足，而瓣膜血栓形成可能是危及生命的并发症。一位希望怀孕且若使用华法林会对胎儿有风险就不想使用该药的女性与我们取得了联系。我们遵循了一个使用高剂量低分子量肝素的方案。剂量根据血液检测结果进行调整，检测结果证实随着孕期进展抗凝需求增加。系列超声心动图检查排除了瓣膜血栓形成。该女性需要全科医生给予心理支持。未发生并发症，她生下了一个健康的孩子。我们描述了患有机械心脏瓣膜的孕妇抗凝治疗的各种替代方案。必须与该女性充分讨论抗凝方案的选择及其后果。
