Armstrong Emily M, Bellone Jessica M, Hornsby Lori B, Treadway Sarah, Phillippe Haley M
Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA.
J Pharm Pract. 2014 Jun;27(3):243-52. doi: 10.1177/0897190014530425. Epub 2014 Apr 17.
Pregnancy is associated with an increased risk of venous thromboembolism (VTE), with a reported incidence ranging from 0.49 to 2 events per 1000 deliveries. Risk factors include advanced maternal age, obesity, smoking, and cesarian section. Women with a history of previous VTE are at a 4-fold higher risk of recurrent thromboembolic events during subsequent pregnancies. Additionally, the presence of concomitant thrombophilia, particularly factor V Leiden (homozygosity), prothrombin gene mutation (homozygosity), or antiphospholipid syndrome (APS), increases the risk of pregnancy-related VTE. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are the drugs of choice for anticoagulation during pregnancy. LMWH is preferred due to ease of use and lower rates of adverse events. Women with high thromboembolic risk particularly those with a family history of VTE should receive antepartum thromboprophylaxis. Women with low thromboembolic risk or previous VTE caused by a transient risk factor (ie, provoked), who have no family history of VTE, may undergo antepartum surveillance. Postpartum anticoagulation can be considered in women with both high and low thromboembolic risk.
妊娠与静脉血栓栓塞（VTE）风险增加相关，据报道发病率为每1000例分娩中有0.49至2例。风险因素包括高龄产妇、肥胖、吸烟和剖宫产。既往有VTE病史的女性在随后妊娠期间发生复发性血栓栓塞事件的风险高4倍。此外，合并存在血栓形成倾向，特别是因子V莱顿（纯合子）、凝血酶原基因突变（纯合子）或抗磷脂综合征（APS），会增加妊娠相关VTE的风险。低分子量肝素（LMWH）和普通肝素（UFH）是妊娠期抗凝治疗的首选药物。由于使用方便且不良事件发生率较低，LMWH更受青睐。血栓栓塞风险高的女性，尤其是有VTE家族史的女性，应接受产前血栓预防。血栓栓塞风险低或既往由短暂风险因素（即诱发因素）导致VTE且无VTE家族史的女性，可进行产前监测。血栓栓塞风险高和低的女性产后均可考虑抗凝治疗。
