Letsky E A
Queen Charlotte's & Chelsea Hospital, London, UK.
Baillieres Clin Obstet Gynaecol. 1997 Sep;11(3):523-43. doi: 10.1016/s0950-3552(97)80026-0.
It is important to continue or introduce prophylaxis of thrombo-embolism before elective delivery or during labour if the incidence of post partum thrombo-embolism is to be reduced. Women with previous thrombo-embolism, genetic or acquired thrombophilia should receive intrapartum and post partum prophylaxis for at least six weeks. Those having operative delivery may require prophylaxis for a shorter period if there are no other risk factors. Subcutaneous unfractionated or low molecular weight heparins are the anticoagulants of choice. Available evidence shows that the use of prophylactic heparin during the course of epidural or spinal anaesthesia does not increase the risk of local haematoma although this remains an actively controversial area. To reduce the risk of osteopenia associated with long-term therapy and relieve the women of the onus of self-administered injections, heparin may be replaced by warfarin post-partum even if the mother is breastfeeding but warfarin dosage, unlike heparin, will require careful monitoring.
若要降低产后血栓栓塞的发生率，在择期分娩前或分娩期间持续进行或开始预防血栓栓塞至关重要。有既往血栓栓塞史、遗传性或获得性血栓形成倾向的女性，应接受产时及产后至少六周的预防措施。若没有其他危险因素，接受手术分娩的女性可能需要较短时间的预防措施。皮下注射普通肝素或低分子肝素是首选的抗凝剂。现有证据表明，在硬膜外或脊髓麻醉过程中使用预防性肝素不会增加局部血肿的风险，尽管这仍是一个存在激烈争议的领域。为降低与长期治疗相关的骨质减少风险，并减轻女性自我注射的负担，即使母亲正在母乳喂养，产后肝素也可被华法林替代，但与肝素不同，华法林的剂量需要仔细监测。
