Radakrishnan Archanna, Dokko Julia, Pastena Paola, Kalogeropoulos Andreas P
Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
J Thorac Dis. 2024 Jan 30;16(1):645-660. doi: 10.21037/jtd-23-945. Epub 2024 Jan 16.
Women with peripartum cardiomyopathy (PPCM) are at an increased risk of arterial and venous thromboembolic events. The review summarizes the evidence on the incidence of thromboembolic complications in women with PPCM, diagnostic approaches, related outcomes, and effects of therapies that have been used.
English articles were retrieved from Web of Science and PubMed using search terms to capture studies related to PPCM (or postpartum cardiomyopathy) and all combinations of thrombosis- and embolism-related keywords. A total of 347 articles from PubMed and 85 from Web of Science were obtained, and after removing duplicates, 327 articles were screened for original data and classified into four domains: epidemiology, risk factors, diagnosis, and therapy of thromboembolism in PPCM. Ultimately, 30 articles were included. Data were synthesized in summary tables for each domain.
Studies in the United States and Europe reported varying incidence for thromboembolism in PPCM, up to 14% in 6 months. Risk factors include elevated levels of coagulation factors, decreased protein C and S activity, decreased fibrinolysis, and a low left ventricular ejection fraction (LVEF). Cesarean delivery and post-operative status were correlated with a higher incidence of thromboembolic complications. Diagnosis relied mostly on ultrasonography and magnetic resonance and depended on the suspected location of thrombus. Anticoagulation has been used mostly for PPCM patients with a reduced LVEF, with the duration varying across guidelines and healthcare systems. Unfractionated heparin and low molecular weight heparin (LMWH) were considered safe choices during pregnancy, while warfarin and novel oral anticoagulants (NOACs) were used postpartum. The association of bromocriptine with risk of thromboembolic complications remains debated.
There are important gaps in our understanding of the epidemiology, risk stratification, and optimal secondary prevention of thromboembolism in PPCM. Larger prospective studies with detailed phenotyping are required.
围产期心肌病（PPCM）女性发生动脉和静脉血栓栓塞事件的风险增加。本综述总结了PPCM女性血栓栓塞并发症的发生率、诊断方法、相关结局以及所使用治疗方法的效果等方面的证据。
使用检索词从科学网和PubMed中检索英文文章，以获取与PPCM（或产后心肌病）以及血栓形成和栓塞相关关键词的所有组合相关的研究。从PubMed获得347篇文章，从科学网获得85篇文章，去除重复项后，筛选327篇文章的原始数据，并将其分为四个领域：PPCM血栓栓塞的流行病学、危险因素、诊断和治疗。最终纳入30篇文章。数据在每个领域的汇总表中进行综合。
美国和欧洲的研究报告了PPCM血栓栓塞的不同发生率，6个月内高达14%。危险因素包括凝血因子水平升高、蛋白C和S活性降低、纤溶降低以及左心室射血分数（LVEF）降低。剖宫产和术后状态与血栓栓塞并发症的较高发生率相关。诊断主要依靠超声检查和磁共振成像，并取决于血栓的疑似位置。抗凝治疗主要用于LVEF降低的PPCM患者，不同指南和医疗系统的治疗持续时间有所不同。普通肝素和低分子肝素（LMWH）在孕期被认为是安全选择，而华法林和新型口服抗凝药（NOACs）在产后使用。溴隐亭与血栓栓塞并发症风险的关联仍存在争议。
我们对PPCM血栓栓塞的流行病学、风险分层以及最佳二级预防的理解存在重要差距。需要开展更大规模的前瞻性研究并进行详细的表型分析。
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