Turrentine M A, Braems G, Ramirez M M
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Texas Health Science Center, Houston 77030, USA.
Obstet Gynecol Surv. 1995 Jul;50(7):534-41. doi: 10.1097/00006254-199507000-00020.
The incidence of thromboembolic disease is increased during pregnancy. Prevention and treatment of thromboembolic disease can have a significant impact on the morbidity and mortality of pregnant women. Anticoagulation with heparin is the treatment of choice; however, in some instances this is inadequate or contraindicated. In the nonpregnant patient, alternative therapies have included surgical intervention or fibrinolytic agents. Traditionally, thrombolytic therapy has been considered a relative contraindication during pregnancy due to the maternal and fetal risk of hemorrhagic complications. Hence, no controlled trials of agents such as streptokinase, urokinase, or tissue plasminogen activator for the treatment of thromboembolic events during pregnancy, have been performed, or are currently feasible. Since 1961, 36 reports have been published describing the use of thrombolytic agents during pregnancy. In a review of the world's literature, 172 pregnant women affected with thromboembolic conditions were treated with thrombolytic medications. A maternal mortality rate of 1.2 percent was observed. Approximately 10 pregnancy losses were noted (5.8 percent). Hemorrhagic complications were reported in 8.1 percent of patients. We summarize the published literature on the use of thrombolytic agents during pregnancy and discuss the treatment success and reported complications.
血栓栓塞性疾病的发病率在孕期会升高。血栓栓塞性疾病的预防和治疗对孕妇的发病率和死亡率会产生重大影响。肝素抗凝是首选治疗方法；然而，在某些情况下，这种方法并不充分或存在禁忌。对于非妊娠患者，替代疗法包括手术干预或纤溶药物。传统上，由于存在母婴出血并发症的风险，溶栓治疗在孕期一直被视为相对禁忌。因此，尚未进行且目前也无法进行关于链激酶、尿激酶或组织纤溶酶原激活剂等药物用于治疗孕期血栓栓塞事件的对照试验。自1961年以来，已发表36篇报告描述孕期使用溶栓药物的情况。在对世界文献的综述中，172例患有血栓栓塞性疾病的孕妇接受了溶栓药物治疗。观察到孕产妇死亡率为1.2%。记录到约10例妊娠丢失（5.8%）。8.1%的患者报告有出血并发症。我们总结了已发表的关于孕期使用溶栓药物的文献，并讨论了治疗效果和报告的并发症。
