Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha 410011.
Xiangya School of Medicine, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Feb 28;46(2):207-211. doi: 10.11817/j.issn.1672-7347.2021.200645.
Anticoagulation drugs should be used for patients with mechanical heart valve (MHV) in case of potential risk of thrombosis. Pregnant women with MHV have to change therapies due to teratogenic effect of some anti-coagulation drugs. European Society of Cardiology clinical guidelines for the management of cardiovascular diseases during pregnancy gives specific suggestions for anticoagulation therapy.We have treated 2 patients with mechanical heart valve thrombosis (MVT) during pregnancy: One received low molecular weight heparin (LMWH) throughout the pregnancy and developed MVT at the third trimester of pregnancy; one developed MVT at the first trimester when replacing vitamin K antagonists (VKA) with LMWH. These patients raised secondary reflection on the balance between clinical guideline and personalized medicine. During LMWH therapy, we should dynamically monitor patients' anti-activated factor X (anti-Xa) level to evaluate coagulation function during pregnancy. When a pregnant woman with MHV develops symptoms of acute heart failure, stuck mechanical valve should be paid attention to and surgery should be promptly performed if necessary.
对于有机械心脏瓣膜（MHV）的患者，如果存在潜在血栓形成风险，应使用抗凝药物。由于某些抗凝药物的致畸作用，患有 MHV 的孕妇必须改变治疗方法。欧洲心脏病学会妊娠期间心血管疾病管理临床指南为抗凝治疗提供了具体建议。我们在妊娠期间治疗了 2 例机械心脏瓣膜血栓形成（MVT）患者：1 例在整个妊娠期间接受低分子量肝素（LMWH）治疗，在妊娠晚期发生 MVT；1 例在改用 LMWH 时在孕早期发生 MVT。这些患者对临床指南和个性化医学之间的平衡提出了二次反思。在 LMWH 治疗期间，我们应动态监测患者的抗活化因子 X（抗-Xa）水平，以评估妊娠期间的凝血功能。当患有 MHV 的孕妇出现急性心力衰竭症状时，应注意机械瓣卡住，并在必要时及时进行手术。
