Conard J, Horellou M H, Samama M M
Service d'hématologie biologique, hôpital Hôtel-Dieu, Parvis-Notre-Dame, 75181 Paris cedex 04, France.
J Mal Vasc. 2009 Nov;34(5):300-13. doi: 10.1016/j.jmv.2009.07.002.
Guidelines concerning the prevention and treatment of pregnancy-associated venous thromboembolism (VTE) have been elaborated by the American College of Chest Physicians and published in Chest in 2008. In this review, they have been compared with European guidelines and discussed taking into account the papers published since 2008.Most recommendations are of low grade of evidence because randomized studies are lacking during pregnancy and many reflect guidelines proposed by experts. The decisions on the most appropriate prophylaxis, dose to be administered and moment of pregnancy for starting prophylaxis are often decided case by case after careful assessment of the risk of pregnancy-associated VTE, on one hand, and the risk for the mother, on the other.Risk factors (age >or= 35, obesity, history of VTE with or without sequellae, in vitro fertilization)or thrombophilia have to be taken into account. Scores have been proposed to improve standardisation and evaluation of the risk of VTE and they should be validated.
美国胸科医师学会已制定了关于妊娠相关静脉血栓栓塞症（VTE）预防和治疗的指南，并于2008年发表在《胸科》杂志上。在本综述中，将这些指南与欧洲指南进行了比较，并结合2008年以来发表的论文进行了讨论。大多数建议的证据等级较低，因为孕期缺乏随机研究，许多建议反映的是专家提出的指南。关于最合适的预防措施、给药剂量以及开始预防的孕周的决定，通常在仔细评估妊娠相关VTE风险以及母亲风险后逐案做出。必须考虑风险因素（年龄≥35岁、肥胖、有或无后遗症的VTE病史、体外受精）或易栓症。已提出评分系统以提高VTE风险标准化和评估水平，并且这些评分系统应得到验证。
