Brill-Edwards P, Ginsberg J S, Gent M, Hirsh J, Burrows R, Kearon C, Geerts W, Kovacs M, Weitz J I, Robinson K S, Whittom R, Couture G
McMaster University Medical Centre, Hamilton, Ont, Canada.
N Engl J Med. 2000 Nov 16;343(20):1439-44. doi: 10.1056/NEJM200011163432002.
Women with a history of venous thromboembolism may be at increased risk for venous thromboembolic events during pregnancy. In these women, the decision to give or withhold heparin in the antepartum period is controversial, because accurate estimates of the frequency of recurrent thromboembolic events if antepartum heparin is withheld are not available.
We prospectively studied 125 pregnant women with a single previous episode of venous thromboembolism. Antepartum heparin was withheld, but anticoagulant therapy was given for four to six weeks post partum. Our primary objective was to determine the rate of antepartum recurrence of venous thromboembolism. Laboratory studies were performed to identify thrombophilia in 95 women.
Three of the 125 women (2.4 percent) had an antepartum recurrence of venous thromboembolism (95 percent confidence interval, 0.2 to 6.9 percent). There were no recurrences in the 44 women who had no evidence of thrombophilia and who also had a previous episode of thrombosis that was associated with a temporary risk factor. Among the 51 women with abnormal laboratory results or a previous episode of idiopathic thrombosis, or both, 3 (5.9 percent) had an antepartum recurrence of venous thromboembolism (95 percent confidence interval, 1.2 to 16.2 percent).
The risk of recurrent antepartum venous thromboembolism in women with a history of venous thromboembolism is low, and therefore routine antepartum prophylaxis with heparin is not warranted.
有静脉血栓栓塞病史的女性在孕期发生静脉血栓栓塞事件的风险可能会增加。对于这些女性，在产前给予或停用肝素的决定存在争议，因为如果停用产前肝素，目前尚无关于复发性血栓栓塞事件发生率的准确估计。
我们前瞻性地研究了125例既往有单次静脉血栓栓塞发作史的孕妇。产前停用肝素，但产后给予抗凝治疗4至6周。我们的主要目标是确定产前静脉血栓栓塞的复发率。对95例女性进行了实验室检查以确定是否存在易栓症。
125例女性中有3例（2.4%）发生产前静脉血栓栓塞复发（95%置信区间为0.2%至6.9%）。44例无易栓症证据且既往血栓形成发作与临时危险因素相关的女性中无复发。在51例实验室检查结果异常或既往有特发性血栓形成发作或两者皆有的女性中，3例（5.9%）发生产前静脉血栓栓塞复发（95%置信区间为1.2%至16.2%）。
有静脉血栓栓塞病史的女性产前复发性静脉血栓栓塞的风险较低，因此不建议常规产前使用肝素进行预防。
