Masamoto Hitoshi, Uehara Hiroyuki, Mekaru Keiko, Uezato Tadakazu, Sakumoto Kaoru, Aoki Yoichi
Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Am J Perinatol. 2009 Sep;26(8):597-600. doi: 10.1055/s-0029-1220781. Epub 2009 Apr 29.
Warfarin-associated fetal hemorrhage is a fatal event. We report the case of a 39-year-old woman who had been taking warfarin for 23 years since undergoing mitral valve replacement. Thereafter, when she was found to be pregnant, the medication was switched to heparin from 6 to 21 weeks of gestation. Following this, she was prescribed oral warfarin again (3.5 mg per day), with a strict control of prothrombin time/international normalized ratio (PT/INR). At 23 weeks of gestation, fetal intracranial hemorrhage occurred because of maternal exposure to warfarin. Maternal PT/INR does not correlate well with the activity of warfarin in the fetus and currently, there is no direct way to prevent fetal intracranial hemorrhage. Hence, further research on the optimal coagulation therapy in pregnant women with valve replacement should be encouraged.
华法林相关的胎儿出血是一种致命事件。我们报告了一名39岁女性的病例，该女性自二尖瓣置换术后服用华法林已有23年。此后，当她被发现怀孕时，在妊娠6至21周期间将药物换成了肝素。在此之后，她再次被处方口服华法林（每天3.5毫克），并严格控制凝血酶原时间/国际标准化比值（PT/INR）。在妊娠23周时，由于母亲服用华法林，胎儿发生了颅内出血。母亲的PT/INR与华法林在胎儿体内的活性相关性不佳，目前尚无直接方法预防胎儿颅内出血。因此，应鼓励对瓣膜置换术后孕妇的最佳凝血治疗进行进一步研究。
