Strategy of anticoagulation therapy during pregnancy in patients with mechanical heart valve_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Han ,  DONG Li

Deparment of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

DONG Li, Email: donglikn199@163.com

Keywords：

Pregnancy; mechanical heart valves; prosthetic heart valves; warfarin

DOI：

10.7507/1007-4848.201607016

Video：

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Abstract Full text Figures/Tables Video References Cited by

The management of women with mechanical heart valves during pregnancy remains difficult and controversial. The selection of prosthetic heart valve, management during pregnancy and delivery period, guidelines and anticoagulation strategy used in patients with a mechanical heart valve in China are summarized in this review.

Citation： CHENG Han, DONG Li. Strategy of anticoagulation therapy during pregnancy in patients with mechanical heart valve. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 83-89. doi: 10.7507/1007-4848.201607016 Copy

1.	石應康. 我國胸心血管外科發展現狀與趨勢——中華醫學會第 13 次全國胸心血管外科學術會議熱點解讀. 中國胸心血管外科臨床雜志, 2014, 21(1): 1-2.
2.	Becker RC, Eisenberg P, Turpie AG. Pathobiologic features and prevention of thrombotic complications associated with prosthetic heart valves: fundamental principles and the contribution of platelets and thrombin. Am Heart J, 2001, 141(6): 1025-1037.
3.	Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol, 2010, 55(22): 2413-2426.
4.	Avila WS, Rossi EG, Grinberg M, et al. Influence of pregnancy after bioprosthetic valve replacement in young women: a prospective five-year study. J Heart Valve Dis, 2002, 11(6): 864-869.
5.	EI SF, Hassan W, Latroche B, et al. Pregnancy has no effect on the rate of structural deterioration of bioprosthetic valves: long-term 18-year follow up results. J Heart Valve Dis, 2005, 14(4): 481-485.
6.	佟春盛. 冠狀動脈旁路移植術同期行心臟瓣膜手術的方法及療效. 中國繼續醫學教育, 2016, 8(6): 103-104.
7.	Salazar E, Izaguirre R. Heart disease, anticoagulants and pregnancy. Rev Esp Cardiol, 2001, 54 (Suppl 1): 8-16.
8.	吳昊, 肖春暉, 祝明華. 心臟機械瓣膜置換術后以國際標準化比值目標為 1.8～2.5 下華法林用量影響因素. 中國鄉村醫藥, 2017, 24(12): 24-25.
9.	Sillesen M, Hjortdal V, Niels V, et al. Pregnancy with prosthetic heart valves — 30 years’ nationwide experience in Denmark. Eur J Cardio-thoracic Surg, 2011, 40(2): 448-454.
10.	van Hagen IM, Roos-Hesselink JW, Ruys TP, et al. Pregnancy in women with a mechanical heart valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation, 2015, 132(2): 132-142.
11.	Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
12.	Cotrufo M, De Feo M, De Santo LS, et al. Risk of warfarin during pregnancy with mechanical valve prostheses. Obstet Gynecol, 2002, 99(1): 35-40.
13.	趙樹林, 董力, 石應康, 等. 心臟瓣膜置換術后抗凝治療自我監測的臨床研究. 四川大學學報 (醫學版), 2014, 45(5): 844-847.
14.	Chen QL, Dong L, Dong YJ, et al. Security and cost comparison of INR self-testing and conventional hospital INR testing in patients with mechanical heart valve replacement. J Cardiothorac Surg, 2015, 10: 4.
15.	陳秋林, 董力, 石應康, 等. 心臟機械瓣膜置換術后不同抗凝監測模式的非隨機對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 646-652.
16.	Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol, 2004, 191(3): 1024-1029.
17.	Lee JH, Park NH, Keum DY, et al. Low molecular weight heparin treatment in pregnant women with a mechanical heart valve prosthesis. J Korean Med Sci, 2007, 22(2): 258-261.
18.	Friedrich E, Hameed AB. Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy. J Perinatol, 2010, 30(4): 253-257.
19.	Yinon Y, Siu SC, Warshafsky C, et al. Use of low molecular weight heparin in pregnant women with mechanical heart valves. Am J Cardiol, 2009, 104(9): 1259-1263.
20.	Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
21.	Al-Lawati AA, Venkitraman M, Al-Delaime T, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. Eur J Cardiothorac Surg, 2002, 22(2): 223-227.
22.	李濤, 賴怡, 邊策, 等. 機械心臟瓣膜置換術后孕早期肝素替代華法林抗凝治療對妊娠結局影響的 Meta 分析. 中國循證醫學雜志, 2008, 8(1): 42-48.
23.	Alonso Gómez AM, Comín J, Borrás X, et al. Comments on the ESC guidelines on the management of cardiovascular diseases during pregnancy. A critical vision of Spanish cardiology. Rev Esp Cardiol (Engl Ed), 2012, 65(2): 113-118.
24.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
25.	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. Chest, 2012, 141(2 Suppl): e691S-e736S.
26.	付博, 董力, 石應康. 中國人心臟瓣膜置換術后抗凝治療數據庫建設. 中國胸心血管外科臨床雜志, 2013, 20(1): 3-9.
27.	張小飛, 肖亦敏, 程云閣, 等. 心臟機械瓣膜置換術后華法林低強度抗凝治療的臨床分析. 中國胸心血管外科臨床雜志, 2014, 21(2): 270-271.
28.	董力, 石應康, 許建屏, 等. 中國心臟瓣膜術后多中心低強度抗凝治療注冊登記及隨訪研究. 中華醫學雜志, 2016, 96(19): 1489-1494.
29.	董力, 劉興會, 石應康, 等. 心臟機械瓣膜置換術后妊娠婦女低強度華法林抗凝治療 56 例. 中華胸心血管外科雜志, 2011, 27(1): 8-10.
30.	匡鋒, 周新民, 尹邦良, 等. 心臟瓣膜置換術后婦女妊娠全程口服華法令抗凝觀察 103 例. 中國胸心血管外科臨床雜志, 2011, 18(4): 321-324.
31.	胡小平, 韓風珍, 周沫. 心臟機械瓣膜置換后妊娠期抗凝藥物的使用. 中國婦幼保健, 2005, 20(20): 2661-2663.
32.	蔡杰, 張凱倫, 蔣雄剛, 等. 機械瓣置換術后妊娠期抗凝策略. 中國醫師雜志, 2011, 13(5): 668-669.
33.	汪建軍, 李斌, 劉陶. 風濕性心臟病術后妊娠 37 例分析. 中國實用婦科與產科雜志, 2004, 20(3): 174-175.
34.	席愛萍, 郝占平, 唐英杰, 等. VKORC1-1639A/G 基因多態性對機械心臟瓣膜置換術后妊娠期華法林抗凝效果的影響. 中國煤炭工業醫學雜志, 2014, (11): 1795-1798.
35.	鄭珞, 徐霞, 鄭志群. 機械瓣置換術后孕期全程口服華法令抗凝 31 例臨床觀察.海南醫學, 2013, 24(22): 3322-3324.
36.	李斌, 李玲玲. 心臟機械瓣膜置換術后妊娠與分娩分析. 中國實用醫藥, 2013, 8(2): 32-33.
37.	薛秀珍. 心臟換瓣術后妊娠分娩 36 例臨床觀察. 中國婦幼保健, 2007, 22(13): 1753-1754.
38.	古航, 胡電, 沙金燕, 等. 78 例心臟瓣膜置換術后妊娠及分娩期抗凝方案探討. 醫學臨床研究, 2002, 19(12): 522-523.
39.	黃東霞, 嚴坤, 蔡汝文, 等. 影響心臟瓣膜置換術術后妊娠結局的多因素分析. 中國當代醫藥, 2013, 20(15): 19-20, 22.
40.	蔣露, 楊凡, 李永波, 等. 機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探. 中國循證醫學雜志, 2012, 12(5): 516-519.
41.	嚴坤, 黃東霞, 黃夏鐸. 低分子肝素鈉在心臟病換瓣術后妊娠早期的應用探討. 國際醫藥衛生導報, 2012, 18(1): 71-74.
42.	Castellano JM, Narayan RL, Vaishnava P, et al. Anticoagulation during pregnancy in patients with a prosthetic heart valve. Nat Rev Cardiol, 2012, 9(7): 415-424.
43.	McLintock C. Anticoagulant therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127(Suppl 3): S56-S60.
44.	張曉紅. 機械瓣膜置換術后抗凝治療和圍分娩期處理. 中華產科急救電子雜志, 2014, 3(2): 109-113.
45.	張崢, 李斌, 譚玉潔. 心臟機械瓣膜置換術后患者妊娠與分娩臨床分析. 新鄉醫學院學報, 2012, 29(9): 709-710.

1. 石應康. 我國胸心血管外科發展現狀與趨勢——中華醫學會第 13 次全國胸心血管外科學術會議熱點解讀. 中國胸心血管外科臨床雜志, 2014, 21(1): 1-2.
2. Becker RC, Eisenberg P, Turpie AG. Pathobiologic features and prevention of thrombotic complications associated with prosthetic heart valves: fundamental principles and the contribution of platelets and thrombin. Am Heart J, 2001, 141(6): 1025-1037.
3. Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol, 2010, 55(22): 2413-2426.
4. Avila WS, Rossi EG, Grinberg M, et al. Influence of pregnancy after bioprosthetic valve replacement in young women: a prospective five-year study. J Heart Valve Dis, 2002, 11(6): 864-869.
5. EI SF, Hassan W, Latroche B, et al. Pregnancy has no effect on the rate of structural deterioration of bioprosthetic valves: long-term 18-year follow up results. J Heart Valve Dis, 2005, 14(4): 481-485.
6. 佟春盛. 冠狀動脈旁路移植術同期行心臟瓣膜手術的方法及療效. 中國繼續醫學教育, 2016, 8(6): 103-104.
7. Salazar E, Izaguirre R. Heart disease, anticoagulants and pregnancy. Rev Esp Cardiol, 2001, 54 (Suppl 1): 8-16.
8. 吳昊, 肖春暉, 祝明華. 心臟機械瓣膜置換術后以國際標準化比值目標為 1.8～2.5 下華法林用量影響因素. 中國鄉村醫藥, 2017, 24(12): 24-25.
9. Sillesen M, Hjortdal V, Niels V, et al. Pregnancy with prosthetic heart valves — 30 years’ nationwide experience in Denmark. Eur J Cardio-thoracic Surg, 2011, 40(2): 448-454.
10. van Hagen IM, Roos-Hesselink JW, Ruys TP, et al. Pregnancy in women with a mechanical heart valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation, 2015, 132(2): 132-142.
11. Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
12. Cotrufo M, De Feo M, De Santo LS, et al. Risk of warfarin during pregnancy with mechanical valve prostheses. Obstet Gynecol, 2002, 99(1): 35-40.
13. 趙樹林, 董力, 石應康, 等. 心臟瓣膜置換術后抗凝治療自我監測的臨床研究. 四川大學學報 (醫學版), 2014, 45(5): 844-847.
14. Chen QL, Dong L, Dong YJ, et al. Security and cost comparison of INR self-testing and conventional hospital INR testing in patients with mechanical heart valve replacement. J Cardiothorac Surg, 2015, 10: 4.
15. 陳秋林, 董力, 石應康, 等. 心臟機械瓣膜置換術后不同抗凝監測模式的非隨機對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 646-652.
16. Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol, 2004, 191(3): 1024-1029.
17. Lee JH, Park NH, Keum DY, et al. Low molecular weight heparin treatment in pregnant women with a mechanical heart valve prosthesis. J Korean Med Sci, 2007, 22(2): 258-261.
18. Friedrich E, Hameed AB. Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy. J Perinatol, 2010, 30(4): 253-257.
19. Yinon Y, Siu SC, Warshafsky C, et al. Use of low molecular weight heparin in pregnant women with mechanical heart valves. Am J Cardiol, 2009, 104(9): 1259-1263.
20. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
21. Al-Lawati AA, Venkitraman M, Al-Delaime T, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. Eur J Cardiothorac Surg, 2002, 22(2): 223-227.
22. 李濤, 賴怡, 邊策, 等. 機械心臟瓣膜置換術后孕早期肝素替代華法林抗凝治療對妊娠結局影響的 Meta 分析. 中國循證醫學雜志, 2008, 8(1): 42-48.
23. Alonso Gómez AM, Comín J, Borrás X, et al. Comments on the ESC guidelines on the management of cardiovascular diseases during pregnancy. A critical vision of Spanish cardiology. Rev Esp Cardiol (Engl Ed), 2012, 65(2): 113-118.
24. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
25. 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. Chest, 2012, 141(2 Suppl): e691S-e736S.
26. 付博, 董力, 石應康. 中國人心臟瓣膜置換術后抗凝治療數據庫建設. 中國胸心血管外科臨床雜志, 2013, 20(1): 3-9.
27. 張小飛, 肖亦敏, 程云閣, 等. 心臟機械瓣膜置換術后華法林低強度抗凝治療的臨床分析. 中國胸心血管外科臨床雜志, 2014, 21(2): 270-271.
28. 董力, 石應康, 許建屏, 等. 中國心臟瓣膜術后多中心低強度抗凝治療注冊登記及隨訪研究. 中華醫學雜志, 2016, 96(19): 1489-1494.
29. 董力, 劉興會, 石應康, 等. 心臟機械瓣膜置換術后妊娠婦女低強度華法林抗凝治療 56 例. 中華胸心血管外科雜志, 2011, 27(1): 8-10.
30. 匡鋒, 周新民, 尹邦良, 等. 心臟瓣膜置換術后婦女妊娠全程口服華法令抗凝觀察 103 例. 中國胸心血管外科臨床雜志, 2011, 18(4): 321-324.
31. 胡小平, 韓風珍, 周沫. 心臟機械瓣膜置換后妊娠期抗凝藥物的使用. 中國婦幼保健, 2005, 20(20): 2661-2663.
32. 蔡杰, 張凱倫, 蔣雄剛, 等. 機械瓣置換術后妊娠期抗凝策略. 中國醫師雜志, 2011, 13(5): 668-669.
33. 汪建軍, 李斌, 劉陶. 風濕性心臟病術后妊娠 37 例分析. 中國實用婦科與產科雜志, 2004, 20(3): 174-175.
34. 席愛萍, 郝占平, 唐英杰, 等. VKORC1-1639A/G 基因多態性對機械心臟瓣膜置換術后妊娠期華法林抗凝效果的影響. 中國煤炭工業醫學雜志, 2014, (11): 1795-1798.
35. 鄭珞, 徐霞, 鄭志群. 機械瓣置換術后孕期全程口服華法令抗凝 31 例臨床觀察.海南醫學, 2013, 24(22): 3322-3324.
36. 李斌, 李玲玲. 心臟機械瓣膜置換術后妊娠與分娩分析. 中國實用醫藥, 2013, 8(2): 32-33.
37. 薛秀珍. 心臟換瓣術后妊娠分娩 36 例臨床觀察. 中國婦幼保健, 2007, 22(13): 1753-1754.
38. 古航, 胡電, 沙金燕, 等. 78 例心臟瓣膜置換術后妊娠及分娩期抗凝方案探討. 醫學臨床研究, 2002, 19(12): 522-523.
39. 黃東霞, 嚴坤, 蔡汝文, 等. 影響心臟瓣膜置換術術后妊娠結局的多因素分析. 中國當代醫藥, 2013, 20(15): 19-20, 22.
40. 蔣露, 楊凡, 李永波, 等. 機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探. 中國循證醫學雜志, 2012, 12(5): 516-519.
41. 嚴坤, 黃東霞, 黃夏鐸. 低分子肝素鈉在心臟病換瓣術后妊娠早期的應用探討. 國際醫藥衛生導報, 2012, 18(1): 71-74.
42. Castellano JM, Narayan RL, Vaishnava P, et al. Anticoagulation during pregnancy in patients with a prosthetic heart valve. Nat Rev Cardiol, 2012, 9(7): 415-424.
43. McLintock C. Anticoagulant therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127(Suppl 3): S56-S60.
44. 張曉紅. 機械瓣膜置換術后抗凝治療和圍分娩期處理. 中華產科急救電子雜志, 2014, 3(2): 109-113.
45. 張崢, 李斌, 譚玉潔. 心臟機械瓣膜置換術后患者妊娠與分娩臨床分析. 新鄉醫學院學報, 2012, 29(9): 709-710.

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Strategy of anticoagulation therapy during pregnancy in patients with mechanical heart valve

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