Descarries Laurence M, Leduc Line, Khairy Paul, Mercier Lise-Andrée
Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
J Heart Valve Dis. 2006 Sep;15(5):679-85.
Low-molecular-weight heparin (LMWH) is considered a recommended anticoagulation option in pregnant women with prosthetic heart valves. However, few data are available regarding the efficacy and safety of LMWH in this setting.
In 1999, the authors' institution developed a standardized anticoagulation protocol for pregnant women with prosthetic heart valves, which included LMWH administered between six and 12 weeks' gestation, and after 36 weeks, with prespecified target levels, and additional low-dose aspirin. Herein is presented the initial experience using this anticoagulation regimen.
Among five women with prosthetic heart valves treated with LMWH during part of their pregnancy, four had uneventful pregnancies while one suffered a coronary artery embolus. A review is provided of the current state of knowledge regarding anticoagulation in pregnancy, with emphasis placed on the importance of strict monitoring of anticoagulation levels.
Given the drawbacks of other forms of anticoagulation, and within the constraints of available data, LMWH appears--when administered with caution--to be an acceptable alternative in pregnant women with prosthetic heart valves.
低分子量肝素（LMWH）被认为是患有人工心脏瓣膜的孕妇推荐的抗凝选择。然而，关于LMWH在这种情况下的疗效和安全性的数据很少。
1999年，作者所在机构为患有人工心脏瓣膜的孕妇制定了标准化抗凝方案，包括在妊娠6至12周以及36周后使用LMWH，并设定了预定的目标水平，以及额外的小剂量阿司匹林。本文介绍了使用这种抗凝方案的初步经验。
在五名在孕期部分时间接受LMWH治疗的人工心脏瓣膜女性中，四名妊娠过程顺利，一名发生冠状动脉栓塞。本文综述了孕期抗凝的当前知识状况，强调了严格监测抗凝水平的重要性。
鉴于其他抗凝形式的缺点，以及现有数据的局限性，LMWH在谨慎使用时，似乎是患有人工心脏瓣膜孕妇的一种可接受的替代选择。
