Eldor A
Institute of Hematology, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Thromb Haemost. 2001 Jul;86(1):104-11.
The risk of venous thromboembolism (VTE) in pregnancy is 0.05-1.8%, six times greater than in the non-pregnant state, and pulmonary embolism remains the most common cause of maternal death. Maternal age, previous history of VTE, Caesarean section and the presence of thrombophilia, significantly increase the risk of VTE. Acquired or hereditary thrombophilia occur in almost two-thirds of women presenting with recurrent miscarriages, pre-eclampsia, intrauterine growth restriction, abruptio placentae, or stillbirth, which are associated with microvascular thrombosis in placental blood vessels. Women with VTE during pregnancy and especially those with thrombophilia require individualized management, based on the type of defect, the family history and the presence of additional risk factors. These factors are important in determining the dose and duration of antithrombotic therapy during pregnancy and the puerperium, and the thromboprophylactic strategy for future pregnancies. Oral anticoagulants are now seldom used during pregnancy because of their significant side effects. Low-molecular-weight heparins (LMWHs) are increasingly replacing unfractionated heparin in the prevention and treatment of VTE during pregnancy. LMWHs have also been shown to be effective in improving the outcome of pregnancy in women with previous obstetric complications.
孕期静脉血栓栓塞症（VTE）的风险为0.05%-1.8%，比非孕期高六倍，肺栓塞仍然是孕产妇死亡的最常见原因。产妇年龄、既往VTE病史、剖宫产以及存在血栓形成倾向，均会显著增加VTE风险。在出现复发性流产、子痫前期、胎儿生长受限、胎盘早剥或死产的女性中，近三分之二存在获得性或遗传性血栓形成倾向，这些情况与胎盘血管的微血管血栓形成有关。孕期发生VTE的女性，尤其是有血栓形成倾向的女性，需要根据缺陷类型、家族史以及其他风险因素进行个体化管理。这些因素对于确定孕期和产褥期抗血栓治疗的剂量和持续时间以及未来妊娠的血栓预防策略至关重要。由于口服抗凝剂有显著副作用，现在孕期很少使用。低分子肝素（LMWHs）在孕期VTE的预防和治疗中越来越多地取代了普通肝素。低分子肝素还被证明对改善有既往产科并发症的女性的妊娠结局有效。
