Hirsh J, Cade J F, O'Sullivan E F
Br Med J. 1970 Jan 31;1(5691):270-3. doi: 10.1136/bmj.1.5691.270.
Fourteen patients were treated with anticoagulants during 15 pregnancies. Eleven had venous thrombosis, three with pulmonary embolism; three had prosthetic heart valves; and one had mitral stenosis with pulmonary hypertension. All 15 were treated with heparin and 10 with warfarin. The mean duration of heparin therapy was 4.5 weeks and of warfarin 14 weeks. There were two minor episodes of recurrent thromboembolism and three minor haemorrhagic episodes during anticoagulant therapy. No fetal or neonatal complications occurred.There appears to be no ideal anticoagulant regimen for treating thromboembolic disease in pregnancy. A compromise approach based on experimental and clinical findings is suggested, which is considered to offer reasonable protection to the mother without undue risk to the fetus. This is heparin when an anticoagulant is indicated in the first trimester, after 37 weeks' gestation, and for the treatment of the initial thromboembolic episodes. Oral anticoagulants are used at other times when long-term anticoagulant therapy is indicated.
15次妊娠期间，有14名患者接受了抗凝治疗。其中11人发生静脉血栓形成，3人伴有肺栓塞；3人有人工心脏瓣膜；1人有二尖瓣狭窄伴肺动脉高压。15名患者均接受了肝素治疗，10名患者接受了华法林治疗。肝素治疗的平均时长为4.5周，华法林治疗的平均时长为14周。抗凝治疗期间发生了2次轻度复发性血栓栓塞事件和3次轻度出血事件。未发生胎儿或新生儿并发症。
对于治疗妊娠期血栓栓塞性疾病，似乎不存在理想的抗凝方案。建议基于实验和临床研究结果采取一种折中的方法，这种方法被认为能在不对胎儿造成不当风险的情况下为母亲提供合理的保护。在孕早期、妊娠37周后以及治疗初始血栓栓塞事件时，若需要抗凝治疗则使用肝素。在需要长期抗凝治疗的其他时间使用口服抗凝剂。
