Anticoagulant therapy and delivery period management for pregnancy with valve replacement

doi:10.3877/cma.j.issn.2095-3259.2014.02.008

Abstract

Abstract:

The pregnant women complicating with heart disease, even after valve replacement, still have to confront the problem of pregnancy and delivery. The obstetricians have to face out the difficult problems, such as selection of prosthetic heart valve, preconception consultation, adjustment of coagulation, management during pregnancy and delivery period. The above questions will be discussed in this article.

Key words: Heart valve diseases, Pregnancy, high-Risk, Therapy

Xiaohong Zhang. Anticoagulant therapy and delivery period management for pregnancy with valve replacement[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2014, 03(02): 109-113.

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References 18

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高危因素	低危因素
二尖瓣陈旧机械瓣膜，三尖瓣机械瓣膜心房纤颤，应用肝素血栓形成史	二尖瓣新的机械瓣膜和主动脉瓣机械瓣膜
华法林维持(INR 2.5～3.5)至孕35～36周更换为静脉普通肝素维持(APTT>2.5)至产褥期，联合阿司匹林81～100 mg/d	低分子量肝素皮下注射1次/12 h(抗Xa≥0.6 IU/ml，峰值<1.5 IU/ml)至孕35～36周，其后给予普通肝素静脉注射(APTT>2.0)至产褥期
或者	或者
妊娠12周前低分子量肝素皮下注射1次/12 h，维持抗Xa≥0.7 IU/ml，峰值<1.5 IU/ml；或者普通肝素皮下或静脉注射1次/12 h(维持APTT>2.5)，其后给予华法林维持(INR 2.5～3.5)直至孕35～36周，之后给予普通肝素静脉注射维持(APTT>2.5)至产褥期，联合阿司匹林81～100 mg/d	妊娠12周前予低分子量肝素皮下注射1次/12 h，维持抗Xa≥0.6 IU/ml，峰值<1.5 IU/ml；或普通肝素皮下静脉注射1次/12 h维持(APTT>2.0)，其后华法林维持(INR 2.5～3.0)至孕35～36，之后给予普通肝素静脉注射(APTT>2.0)至产褥期

高危因素	低危因素
二尖瓣陈旧机械瓣膜，三尖瓣机械瓣膜心房纤颤，应用肝素血栓形成史	二尖瓣新的机械瓣膜和主动脉瓣机械瓣膜
华法林维持(INR 2.5～3.5)至孕35～36周更换为静脉普通肝素维持(APTT>2.5)至产褥期，联合阿司匹林81～100 mg/d	低分子量肝素皮下注射1次/12 h(抗Xa≥0.6 IU/ml，峰值<1.5 IU/ml)至孕35～36周，其后给予普通肝素静脉注射(APTT>2.0)至产褥期
或者	或者
妊娠12周前低分子量肝素皮下注射1次/12 h，维持抗Xa≥0.7 IU/ml，峰值<1.5 IU/ml；或者普通肝素皮下或静脉注射1次/12 h(维持APTT>2.5)，其后给予华法林维持(INR 2.5～3.5)直至孕35～36周，之后给予普通肝素静脉注射维持(APTT>2.5)至产褥期，联合阿司匹林81～100 mg/d	妊娠12周前予低分子量肝素皮下注射1次/12 h，维持抗Xa≥0.6 IU/ml，峰值<1.5 IU/ml；或普通肝素皮下静脉注射1次/12 h维持(APTT>2.0)，其后华法林维持(INR 2.5～3.0)至孕35～36，之后给予普通肝素静脉注射(APTT>2.0)至产褥期

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