切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2023, Vol. 12 ›› Issue (01) : 22 -27. doi: 10.3877/cma.j.issn.2095-3259.2023.01.005

专家论坛

围产期易栓症的抗凝治疗
赫英东, 陈倩()   
  1. 100031 北京大学第一医院妇产科
  • 收稿日期:2022-11-15 出版日期:2023-02-18
  • 通信作者: 陈倩

Anticoagulation treatment in the perinatal period for patients with thrombophilia

Yingdong He, Qian Chen()   

  • Received:2022-11-15 Published:2023-02-18
  • Corresponding author: Qian Chen
引用本文:

赫英东, 陈倩. 围产期易栓症的抗凝治疗[J]. 中华产科急救电子杂志, 2023, 12(01): 22-27.

Yingdong He, Qian Chen. Anticoagulation treatment in the perinatal period for patients with thrombophilia[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2023, 12(01): 22-27.

易栓症会增加妊娠期间及产后发生静脉血栓的风险,并且与反复自然流产、子痫前期、胎儿宫内生长受限等不良妊娠结局相关。本文将结合易栓症人群妊娠期处理相关指南和文献,介绍合并易栓症人群妊娠期及产后预防性抗凝治疗以降低血栓和不良妊娠结局风险的方案选择。

Thrombophilia is associated with an increased risk of venous thromboembolism during pregnancy and the postpartum period, and has been linked to adverse outcomes, such as recurrent spontaneous abortion, preeclampsia and fetal growth restriction. This article will review the relevant guidelines and literature on managing patients with thrombophilia in pregnancy, introducing prophylactic anticoagulation therapy options for patients with thrombophilia during pregnancy and the postpartum period to reduce the risk of thrombosis and adverse pregnancy outcomes.

表1 常用抗凝药物治疗方案
表2 遗传性易栓症患者妊娠及产褥期VTE预防方案
表3 APS患者妊娠期抗凝治疗方案
[1]
Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis. 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J]. Chest2012141:e691S-e736S.
[2]
Royal College of Obstetricians & Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium (Green-top Guideline No. 37a) [J]. Green-top Guideline2015(37a):1-40.
[3]
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 197: inherited thrombophilias in pregnancy [J]. Obstetrics and Gynecology2018132(1):e18-e34.
[4]
Bates SM, Middeldorp S, Rodger M, et al. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism [J]. Journal of Thrombosis and Thrombolysis201641:92-128.
[5]
Hirsh J, Warkentin TE, Raschke R, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety [J]. Chest1998114(5):489S-510S.
[6]
Weitz JI. Low-molecular-weight heparins [J]. New England Journal of Medicine1997337(10):688-698.
[7]
Messmore HL, Coyne E, Wehrmacher WH, et al. Studies comparing low molecular weight heparin with heparin for the treatment of thromboembolism: a literature review [J]. Current Pharmaceutical Design200410(9):1001-1010.
[8]
Omri A, Delaloye JF, Andersen H, et al. Low molecular weight heparin Novo (LHN-1) does not cross the placenta during the second trimester of pregnancy [J]. Thrombosis and Haemostasis198961(01):055-056.
[9]
Aguilar D, Goldhaber SZ. Clinical uses of low-molecular-weight heparins [J]. Chest1999115(5):1418-1423.
[10]
Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thrombopro-phylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy [J]. Blood2005106(2):401-407.
[11]
Brenner B, Hoffman R, Carp H, et al. Efficacy and safety of two doses of enoxaparin in women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study [J]. Journal of Thrombosis and Haemostasis20053(2):227-229.
[12]
Warren JE, Simonsen SE, Branch DW, et al. Thromboprophylaxis and pregnancy outcomes in asymptomatic women with inherited thrombophilias [J]. Am J Obstet Gynecol2009200(3):281.e1-281.e5.
[13]
Abbattista M, Gianniello F, Cristina Novembrino C, et.al. Risk of pregnancy-related venous thromboembolism and obstetrical complications in women with inherited type I antithrombin deficiency: a retrospective, single-centre, cohort study [J]. The Lancet Haematology20207(4):e320-e328.
[14]
Rodger MA, Hague WM, Kingdom J, et al. Antepartum dalteparin versus no antepartum dalteparin for the prevention of pregnancy complications in pregnant women with thrombophilia (TIPPS): a multinational open-label randomised trial. TIPPS Investigators [J]. Lancet2014384:1673-1683.
[15]
Cruz-Lemini M, Vázquez JC, Ullmo J, et al. Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis [J]. Am J Obstet Gynecol2022226(2):S1126-S1144.
[16]
低分子肝素防治自然流产中国专家共识编写组. 低分子肝素防治自然流产中国专家共识 [J]. 中华生殖与避孕杂志201838(9):701-708.
[17]
Rodger MA, Gris JC, de Vries JIP, et al. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomized controlled trials. Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group [J]. The Lancet2016388(10060):2629-2641.
[18]
de Vries JIP, van Pampus MG, Hague WM, et al. Low-molecular-weight heparin added to aspirin in the prevention of recurrent early-onset preeclampsia in women with inheritable thrombophilia: the FRUIT-RCT [J]. J Thromb Haemost, 201210(1):64-72.
[19]
Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice [J]. Hypertension201872(1):24-43.
[20]
Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on preeclampsia: a pragmatic guide for first-trimester screening and prevention [J]. J Thromb Haemost2019145(S1):1-33.
[21]
Webster K, Fishburn S, Maresh M, et al. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance [J]. BMJ2019366:l5119.
[22]
American College of Obstetricians and Gynecologists. ACOG practice bulletin no.202: gestational hypertension and preeclampsia [J]. Obstet Gynecol2019133(1):e1-e25.
[23]
中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J]. 中华妇产科杂志202055(4):227-238.
[24]
中华医学会围产医学分会. 产科抗磷脂综合征诊断与处理专家共识 [J]. 中华围产医学杂志202023(8):517-522.
[25]
Gardiner C, Hills J, Machin SJ, et al. Diagnosis of antiphospholipid syndrome in routine clinical practice [J]. Lupus201322(1):18-25.
[26]
Ofer-Shiber S, Molad Y. Frequency of vascular and pregnancy morbidity in patients with low vs. moderate-to-high titers of antiphospholipid antibodies [J]. Blood Coagulation & Fibrinolysis201526(3):261-266.
[27]
Cohn DM, Goddijn M, Middeldorp S, et al. Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy [J]. Journal of Thrombosis and Haemostasis20108(10):2208-2213.
[28]
Boffa MC, Boinot C, De Carolis S, et al. Laboratory criteria of the obstetrical antiphospholipid syndrome. Data from a multicentric prospective European women cohort [J]. Thrombosis and Haemostasis2009102(1):25-28.
[29]
Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, et al. Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry [J]. Rheumatology202059(6):1306-1314.
[30]
Leffert L, Butwick A, Carvalho B, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants [J]. Anesth Analg2018126(3):928-944.
[31]
American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 196: thromboembolism in pregnancy [J]. Obstetrics and Gynecology2018132(1):e1-e17.
[32]
Society for Maternal-Fetal Medicine (SMFM). Society for Maternal-Fetal Medicine Consult Series #51: thromboembolism prophylaxis for cesarean delivery No.196 [J]. Am J Obstet Gynecol2020223(2):B11-B17.
[1] 李钱梅, 何冠南, 赵婧, 陈曦, 唐玉英, 马丽琼, 梁蓉, 袁桃, 李明星. 早孕期低危妊娠和高危妊娠胎盘微血流成像特征及预后分析[J]. 中华医学超声杂志(电子版), 2024, 21(07): 726-732.
[2] 尹宏宇, 吴青青, 李晓菲. 颈后透明层和头臀长在妊娠11~13+6周双胎心脏畸形筛查中的价值[J]. 中华医学超声杂志(电子版), 2024, 21(03): 251-256.
[3] 曹琨芃, 王昕玥, 吴柳希, 邓红艳, 李璐, 徐超丽, 叶新华. 淋巴瘤患者超声引导下颈内静脉置管术后静脉血栓形成的危险因素评估[J]. 中华医学超声杂志(电子版), 2024, 21(03): 310-318.
[4] 刘涵, 刘晓菲, 陈翰翰, 陈延君, 张雁. 妊娠期肉芽肿性乳腺炎一例[J]. 中华乳腺病杂志(电子版), 2024, 18(04): 253-254.
[5] 王啸, 李一凡, 沈素红, 曹国瑞, 史小涛, 袁彦浩, 谭红略. 全膝关节置换术后早期下肢深静脉血栓形成的时空规律[J]. 中华关节外科杂志(电子版), 2024, 18(03): 414-420.
[6] 李欣, 魏艺, 张娟, 张娟娟, 凌秀凤, 赵纯, 张媔秋. 高龄女性冻胚移植周期临床妊娠结局的影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 276-283.
[7] 薛静, 孙雅楠, 朱丽丽, 李淑红. 妊娠期急性脂肪肝孕产妇诊疗及其妊娠结局[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 312-321.
[8] 张静, 刘畅, 华成舸. 妊娠期患者口腔诊疗进展[J]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 340-344.
[9] 何俊, 易淑华, 陈婷婷, 杨玉, 李红雨, 谢飞, 何健. 妊娠并发社区获得性肺炎临床特征及降钙素原和炎症指数对其诊断意义[J]. 中华肺部疾病杂志(电子版), 2024, 17(03): 421-425.
[10] 赵颖, 熊钰. 妊娠合并尿路结石的诊治[J]. 中华产科急救电子杂志, 2024, 13(03): 141-145.
[11] 龚子元, 黄振宇. 妊娠期肠梗阻的诊疗策略[J]. 中华产科急救电子杂志, 2024, 13(03): 152-157.
[12] 肖露, 黄莉萍. 妊娠期急性阑尾炎[J]. 中华产科急救电子杂志, 2024, 13(03): 135-140.
[13] 马睿, 赫英东. 妊娠合并胆石症的诊断和治疗[J]. 中华产科急救电子杂志, 2024, 13(03): 146-151.
[14] 彭小蓉, 莫伟, 李琴, 吴雅琴, 李兰. 妊娠期妇女静脉血栓栓塞症预防的知信行现状及其影响因素分析[J]. 中华介入放射学电子杂志, 2024, 12(03): 274-280.
[15] 唐欣, 翟文海, 王润婷, 周胜宇, 靳航. 补体在缺血性卒中疾病中的研究进展[J]. 中华脑血管病杂志(电子版), 2024, 18(04): 382-392.
阅读次数
全文


摘要