Yinon Yoav, Siu Samuel C, Warshafsky Chelsie, Maxwell Cynthia, McLeod Anne, Colman Jack M, Sermer Mathew, Silversides Candice K
Mount Sinai Hospital, University of Toronto, Canada.
Am J Cardiol. 2009 Nov 1;104(9):1259-63. doi: 10.1016/j.amjcard.2009.06.040. Epub 2009 Sep 16.
There are a number of different anticoagulation options for pregnant women with mechanical heart valves. The purpose of this study was to examine maternal thromboembolic complications in women with mechanical valves treated with low-molecular weight heparin (LMWH) throughout pregnancy. This was a substudy of a larger prospective cohort study of pregnant women with heart disease followed from 1998 to 2008. All pregnant women with mechanical left-sided valves who were treated with LMWH throughout pregnancy were included. Maternal thromboembolic events were defined as valve thrombosis, need for valve replacement, or stroke during pregnancy or postpartum (up to 6 months). Twenty-three pregnancies (17 women) occurred in women treated with LMWH and low-dose aspirin: 15 in women with mechanical mitral valves, 9 in women with mechanical aortic valves, and 1 in a woman with both. There was 1 maternal thromboembolic event (4%), which resulted in maternal and fetal death. Five women (22%) developed other adverse cardiac events during pregnancy. Nine pregnancies (43%) had fetal or neonatal adverse events, 5 of which had favorable outcomes. Three pregnancies were complicated by postpartum hemorrhage. In conclusion, carefully monitored LMWH may be a suitable anticoagulation strategy in pregnant women with mechanical heart valves who are unwilling to use warfarin. However, this group of women remains at risk for maternal cardiac and fetal complications. The occurrence of valve thrombosis resulting in maternal death despite therapeutic anti-Xa levels highlights current limitations with anticoagulation in this population.
对于患有机械心脏瓣膜的孕妇，有多种不同的抗凝选择。本研究的目的是调查在整个孕期接受低分子量肝素（LMWH）治疗的机械瓣膜女性的母体血栓栓塞并发症。这是一项对1998年至2008年随访的患有心脏病的孕妇进行的更大规模前瞻性队列研究的子研究。纳入了所有在整个孕期接受LMWH治疗的患有左侧机械瓣膜的孕妇。母体血栓栓塞事件定义为孕期或产后（至6个月）的瓣膜血栓形成、需要进行瓣膜置换或中风。接受LMWH和低剂量阿司匹林治疗的女性发生了23次妊娠（17名女性）：15次发生在患有机械二尖瓣的女性中，9次发生在患有机械主动脉瓣的女性中，1次发生在同时患有两种瓣膜的女性中。发生了1例母体血栓栓塞事件（4%），导致母体和胎儿死亡。5名女性（22%）在孕期出现了其他不良心脏事件。9次妊娠（43%）出现了胎儿或新生儿不良事件，其中5次结局良好。3次妊娠并发产后出血。总之，对于不愿使用华法林的患有机械心脏瓣膜的孕妇，仔细监测的LMWH可能是一种合适的抗凝策略。然而，这组女性仍然存在母体心脏和胎儿并发症的风险。尽管治疗性抗Xa水平达标，但仍发生瓣膜血栓形成导致母体死亡，这凸显了该人群抗凝治疗目前存在的局限性。
