Anticoagulation treatment in the perinatal period for patients with thrombophilia

doi:10.3877/cma.j.issn.2095-3259.2023.01.005

Abstract

Abstract:

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.

Key words: Thrombosis, Antiphospholipid syndrome, Pregnancy

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.

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References 32

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药物	预防剂量	中等剂量	治疗剂量
依诺肝素	40 mg，皮下注射，1次/d	40 mg，皮下注射，1次/12 h	1 mg/kg，皮下注射，1次/12 h
达肝素钠	5000 U，皮下注射，1次/d	5000 U，皮下注射，1次/12 h	200 U/kg，1次/d；或100 U/kg，1次/12 h，皮下注射
那曲肝素	2850 U，皮下注射，1次/d	—	—
肝素	妊娠早期5000~7500 U，皮下注射，1次/12 h；妊娠中期7500~10 000 U，皮下注射，1次/12 h；妊娠晚期10 000 U，皮下注射，1次/12 h，除非APTT延长	—	10 000 U或者更多，皮下注射，1次/12 h；注射6 h后，根据APTT(1.5－2.5倍参考值)情况调整用药剂量

药物	预防剂量	中等剂量	治疗剂量
依诺肝素	40 mg，皮下注射，1次/d	40 mg，皮下注射，1次/12 h	1 mg/kg，皮下注射，1次/12 h
达肝素钠	5000 U，皮下注射，1次/d	5000 U，皮下注射，1次/12 h	200 U/kg，1次/d；或100 U/kg，1次/12 h，皮下注射
那曲肝素	2850 U，皮下注射，1次/d	—	—
肝素	妊娠早期5000~7500 U，皮下注射，1次/12 h；妊娠中期7500~10 000 U，皮下注射，1次/12 h；妊娠晚期10 000 U，皮下注射，1次/12 h，除非APTT延长	—	10 000 U或者更多，皮下注射，1次/12 h；注射6 h后，根据APTT(1.5－2.5倍参考值)情况调整用药剂量

临床表现	孕期处理	产后处理
低风险易栓症，无VTE病史	监测，不进行抗凝治疗	监测，不进行抗凝治疗；合并其他高危因素，进行预防剂量药物抗凝治疗
低风险易栓症，一级亲属存在VTE病史	监测，不进行抗凝治疗；或预防剂量LMWH治疗	预防性抗凝治疗或中等剂量LMWH
低风险易栓症，曾有一次VTE病史，没有接受长时间抗凝治疗	预防性或中等剂量的LMWH治疗	预防性抗凝治疗或中等剂量LMWH
高风险易栓症，无VTE病史	预防性或中等剂量的LMWH	预防性抗凝治疗或中等剂量LMWH
高风险易栓症，曾有一次VTE病史，或一级亲属有VTE病史，没有接受长时间抗凝治疗	预防性、中等剂量或治疗剂量的LMWH	预防性抗凝治疗或中等剂量－治疗剂量的LMWH至产后6周，治疗剂量应与孕期剂量一致
易栓症合并2次或2次以上VTE病史，没有接受长时间抗凝治疗	中等剂量或治疗剂量的LMWH	中等剂量－治疗剂量的LMWH至产后6周，治疗剂量与孕期剂量一致
易栓症合并2次或2次以上VTE病史，接受长时间抗凝治疗	治疗剂量的LMWH	恢复长期抗凝治疗方案

临床表现	孕期处理	产后处理
低风险易栓症，无VTE病史	监测，不进行抗凝治疗	监测，不进行抗凝治疗；合并其他高危因素，进行预防剂量药物抗凝治疗
低风险易栓症，一级亲属存在VTE病史	监测，不进行抗凝治疗；或预防剂量LMWH治疗	预防性抗凝治疗或中等剂量LMWH
低风险易栓症，曾有一次VTE病史，没有接受长时间抗凝治疗	预防性或中等剂量的LMWH治疗	预防性抗凝治疗或中等剂量LMWH
高风险易栓症，无VTE病史	预防性或中等剂量的LMWH	预防性抗凝治疗或中等剂量LMWH
高风险易栓症，曾有一次VTE病史，或一级亲属有VTE病史，没有接受长时间抗凝治疗	预防性、中等剂量或治疗剂量的LMWH	预防性抗凝治疗或中等剂量－治疗剂量的LMWH至产后6周，治疗剂量应与孕期剂量一致
易栓症合并2次或2次以上VTE病史，没有接受长时间抗凝治疗	中等剂量或治疗剂量的LMWH	中等剂量－治疗剂量的LMWH至产后6周，治疗剂量与孕期剂量一致
易栓症合并2次或2次以上VTE病史，接受长时间抗凝治疗	治疗剂量的LMWH	恢复长期抗凝治疗方案

临床表现	孕期处理	产后处理
aPLs阳性，但既往无血栓或不良妊娠历史	LDA 75~100 mg/d至妊娠36周	预防剂量LMWH产后抗凝1周^[32]
OAPS或非典型OAPS	LDA 75~100 mg/d至妊娠36周联合预防剂量LMWH	预防性或中等剂量LMWH抗凝6周
血栓性APS	LDA 75~100 mg/d至妊娠36周联合治疗剂量的LMWH	中等剂量－治疗剂量的LMWH至产后6周，治疗剂量应与孕期剂量一致
难治性APS	LDA 75~100 mg/d至妊娠36周联合治疗剂量的LMWH；联合使用羟氯喹、小剂量激素	中等剂量－治疗剂量的LMWH至产后6周，治疗剂量应与孕期剂量一致

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