机械心脏瓣膜与妊娠：抗凝相关问题。来自两个产科心脏中心的经验。
Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres.
作者信息
Dos Santos Francois, Baris Lucia, Varley Alice, Cornette Jerome, Allam Joanna, Steer Philip, Swan Lorna, Gatzoulis Michael, Roos-Hesselink Jolien, Johnson Mark R
机构信息
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
出版信息
Obstet Med. 2021 Jun;14(2):95-101. doi: 10.1177/1753495X20924937. Epub 2020 Jun 2.
BACKGROUND
Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres.
METHODS
Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis.
RESULTS
Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39-1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC.
CONCLUSION
Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
背景
患有机械心脏瓣膜的孕妇面临产科/心脏并发症的重大风险。本研究比较了两个产科心脏中心的抗凝管理情况。
方法
对切尔西和威斯敏斯特医院/皇家布朗普顿医院（CR）以及伊拉斯谟医疗中心（EMC）进行回顾性病例记录审查。主要结局指标是机械心脏瓣膜血栓形成。
结果
纳入了CR的19例妊娠和EMC的25例妊娠。在CR，大多数女性在整个孕期都使用低分子量肝素（LMWH），而在EMC，大多数女性在孕早期使用LMWH，在随后的孕期使用维生素K拮抗剂。在CR每月进行抗Xa因子峰值检测，水平为0.39 - 1.51 IU/mL（平均0.82 IU/mL）。围产期抗凝管理不一致。在CR，分娩主要通过剖宫产（74%），在EMC主要通过阴道分娩（64%）。CR没有孕产妇死亡，只有1例机械心脏瓣膜血栓形成。EMC有2例机械心脏瓣膜血栓形成和1例孕产妇死亡。
结论
报告了围产期抗凝策略、抗凝监测和分娩方式的不一致情况。
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