Komori Mayuko, Hayata Eijiro, Nakata Masahiko, Yuzawa Hitomi, Oji Ayako, Morita Mineto
Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Japan.
Department of Cardiology, Toho University Omori Medical Center, Japan.
Case Rep Womens Health. 2020 Apr 3;27:e00200. doi: 10.1016/j.crwh.2020.e00200. eCollection 2020 Jul.
We report the case of a 35-year-old pregnant woman (gravida 3, para 1) with antithrombin deficiency who was successfully treated with apixaban. She had a history of heparin-induced thrombocytopenia and venous thromboembolic events. Pregnancy was confirmed while the patient was having anticoagulant therapy for a persistent thrombus. Choice of anticoagulation during her pregnancy was limited because of her antithrombin deficiency: heparin was not an option because of her history of heparin-induced thrombocytopenia; antithrombin-dependent anticoagulant drugs were not an option because of her antithrombin deficiency, and she preferred outpatient management. Despite the fact that there are no reports of its use in pregnant women, we selected apixaban (10 mg/day), a direct Xa inhibitor, as the best solution. No progression of thrombus was noted during the pregnancy. The newborn baby had no external congenital anomalies, intracranial hemorrhage, or bleeding tendency. Thus, apixaban may be a candidate for anticoagulant therapy in pregnant women with a history of venous thromboembolic events and heparin-induced thrombocytopenia.
我们报告了一例35岁的孕妇（孕3产1），她患有抗凝血酶缺乏症，使用阿哌沙班成功治疗。她有肝素诱导的血小板减少症和静脉血栓栓塞事件的病史。在患者因持续性血栓接受抗凝治疗期间确诊怀孕。由于她的抗凝血酶缺乏，孕期抗凝治疗的选择有限：由于有肝素诱导的血小板减少症病史，肝素不是选择；由于抗凝血酶缺乏，依赖抗凝血酶的抗凝药物也不是选择，并且她倾向于门诊治疗。尽管没有关于其在孕妇中使用的报道，但我们选择了直接Xa因子抑制剂阿哌沙班（10毫克/天）作为最佳解决方案。孕期未发现血栓进展。新生儿没有外部先天性异常、颅内出血或出血倾向。因此，阿哌沙班可能是有静脉血栓栓塞事件和肝素诱导的血小板减少症病史的孕妇抗凝治疗的一个选择。
