Department of Ultrasonography, The Affiliated Hospital of Chengde Medical University, Chengde, China.
Department of Obstetrics, The Affiliated Hospital of Chengde Medical University, Chengde, China.
Medicine (Baltimore). 2022 Dec 30;101(52):e32550. doi: 10.1097/MD.0000000000032550.
Most previous treatment guidelines for pregnant women with mechanical heart valves recommend that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of approximately 1.0 to 1.2 IU/mL, but it is commonly associated with subtherapeutic trough levels, consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6 to 0.7 IU/mL and with peak anti-Xa levels of around 1.0 to 1.2 IU/mL or < 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy. In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy.
In the 1st trimester of pregnancy, a 28-year old pregnant female with a mechanical valve had a significant increase in the aortic valve flow rate and suspected mechanical valve thrombosis.
The peak velocity of the pregnant female aortic mechanical valve increased, and mechanical valve thrombosis was suspected.
We adjusted the enoxaparin sodium dose every 12 hours to 1 injection every 8 hours, with a total daily dose of 160 mL. Based on the original application of LMWH, warfarin (3 mg/day) was recommended.
The pregnant woman delivered a live baby by cesarean section, and the peak flow velocity of the mechanical valve in the aortic position was reduced to nearly equivalent to the patient's pre-pregnancy status. The mother and the baby were in good health at the time of discharge.
LMWH is administered twice daily, and anti-Xa trough levels are mostly in a subtherapeutic state, which may lead to insufficient anticoagulation and thrombosis. Dose-adjusted LMWH thrice daily throughout pregnancy is the recommended treatment for pregnant women with mechanical heart valves. The combination of LMWH and warfarin exhibited good efficacy for the treatment of small thromboses.
大多数关于机械心脏瓣膜孕妇的治疗指南建议低分子肝素（LMWH）应每 12 小时应用一次，并仅按需达到约 1.0 至 1.2 IU/mL 的峰值抗 Xa 水平，但通常与治疗窗下限水平相关，从而导致抗凝不足。我们的病例报告和文献复习表明，应在整个孕期给予剂量调整的（目标抗 Xa 谷值为 0.6 至 0.7 IU/mL，峰值抗 Xa 水平约为 1.0 至 1.2 IU/mL 或 <1.5 IU/mL）LMWH，每日 3 次。此外，这例罕见病例的结果表明，LMWH 和华法林联合使用在治疗妊娠期间小血栓方面是有效的。
在妊娠的第 1 个 trimester，一位 28 岁的妊娠女性机械瓣出现主动脉瓣血流速度显著增加，疑似机械瓣血栓形成。
该孕妇的主动脉机械瓣峰值速度增加，疑似机械瓣血栓形成。
我们将依诺肝素钠的剂量从每 12 小时 1 次调整为每 8 小时 1 次，总日剂量为 160mL。根据 LMWH 的原始应用，建议使用华法林（3mg/天）。
孕妇经剖宫产分娩活婴，主动脉机械瓣位置的峰值流速降低至接近妊娠前状态。母亲和婴儿在出院时状况良好。
LMWH 每日 2 次给药，抗 Xa 谷值水平大多处于治疗窗下限，可能导致抗凝不足和血栓形成。在整个孕期给予剂量调整的 LMWH，每日 3 次是机械性心脏瓣膜孕妇的推荐治疗方法。LMWH 和华法林联合使用对治疗小血栓具有良好的疗效。
