Tawes R L, Kennedy P A, Harris E J, Brown W H, Scribner R G, Sydorak G R, Beare J P
Am J Surg. 1982 Jul;144(1):141-5. doi: 10.1016/0002-9610(82)90615-8.
Despite venous stasis and a hypercoagulable state during pregnancy, the reported incidences of deep venous thrombosis and pulmonary embolism are remarkably low, about 1 in 2,000 and 1 in 10,000 cases, respectively. Mortality from antepartum thromboembolism has been reported in about 15 percent of untreated patients and less than 1 percent of treated patients. Adequate anticoagulant therapy significantly reduces maternal mortality and decreases postpartum morbidity. The proper anticoagulant agent for use during pregnancy has been widely debated. Coumarin compounds pass through the placenta and into the fetus. Hemorrhagic complications in the fetus are uncommon if prothrombin times are carefully controlled and if the drug is discontinued before delivery. However, coumarin during the first trimester has the teratogenic hazard of producing chondrodysplasia punctata. Heparin, in contrast, does not cross the placental barrier and is considered more effective treatment for deep venous thrombosis; however, long-term intravenous administration during pregnancy has been considered both impractical and possibly hazardous due to the risk of osteoporosis after 6 months of therapy. In our study, a combined regimen of intravenous and subcutaneous heparin was used successfully in four women with deep venous thrombosis. One patient who had recurrent embolization while on adequate intravenous heparin underwent vena caval clipping and had an uneventful Cesarian section at term with a normal infant. Another patient also underwent Caesarian section with a normal infant, while the other two women had normal vaginal deliveries at term. Miniheparin therapy was continued for 3 months postpartum, followed by long-term aspirin and Ascriptin therapy. Carefully controlled heparin therapy in a pregnant woman with deep venous thrombosis both safe and beneficial for mother and fetus.
尽管孕期存在静脉淤滞和高凝状态，但报道的深静脉血栓形成和肺栓塞的发生率却非常低，分别约为2000例中有1例和10000例中有1例。据报道，未治疗的患者中约15%会死于产前血栓栓塞，而接受治疗的患者中这一比例不到1%。充分的抗凝治疗可显著降低孕产妇死亡率，并减少产后发病率。孕期使用何种合适的抗凝剂一直存在广泛争议。香豆素类化合物可穿过胎盘进入胎儿体内。如果凝血酶原时间得到仔细控制，且在分娩前停药，胎儿出现出血并发症的情况并不常见。然而，孕早期使用香豆素具有导致点状软骨发育不良的致畸风险。相比之下，肝素不会穿过胎盘屏障，被认为是治疗深静脉血栓更有效的药物；然而，由于治疗6个月后存在骨质疏松的风险，孕期长期静脉给药被认为既不实际又可能有危险。在我们的研究中，静脉和皮下联合使用肝素的方案成功用于4例深静脉血栓形成的女性患者。1例在接受充分静脉肝素治疗时仍反复发生栓塞的患者接受了腔静脉夹闭术，并足月行剖宫产，产下一名正常婴儿。另1例患者也足月行剖宫产，产下一名正常婴儿，而另外两名女性足月顺产。产后继续使用小剂量肝素治疗3个月，随后长期使用阿司匹林和阿scriptin治疗。对患有深静脉血栓形成的孕妇进行仔细控制的肝素治疗对母亲和胎儿都是安全且有益的。
