Lee P K, Wang R Y, Chow J S, Cheung K L, Wong V C, Chan T K
J Am Coll Cardiol. 1986 Jul;8(1):221-4. doi: 10.1016/s0735-1097(86)80116-4.
Adjusted subcutaneous heparin was used for thromboembolism prophylaxis during 18 pregnancies in 16 women with an artificial heart valve. Oral warfarin was replaced by subcutaneous heparin as soon as pregnancy was confirmed. The dosage of heparin was adjusted to maintain a partial thromboplastin time at 1.5 times the control value and treatment was administered during the first trimester and the last 3 weeks of gestation. Warfarin was used between the 13th and 37th week. There were no maternal thromboembolic complications and none of the live-born infants showed congenital malformations, indicating that this regimen is effective. However, there were nine spontaneous abortions, including five that occurred in the first 12 weeks. The early abortions were probably related to warfarin exposure at the beginning of pregnancy. The preconception replacement of warfarin by heparin in these patients may be indicated.
16名有人工心脏瓣膜的女性在18次妊娠期间使用调整剂量的皮下肝素预防血栓栓塞。一旦确认怀孕，口服华法林就被皮下肝素取代。调整肝素剂量以维持部分凝血活酶时间为对照值的1.5倍，并在妊娠前三个月和妊娠最后3周进行治疗。在妊娠第13周至37周期间使用华法林。没有发生母体血栓栓塞并发症，且所有存活婴儿均未出现先天性畸形，表明该方案是有效的。然而，有9例自然流产，其中5例发生在妊娠前12周。早期流产可能与妊娠初期接触华法林有关。这些患者在受孕前用肝素替代华法林可能是合适的。
