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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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.	石应康. 我国胸心血管外科发展现状与趋势——中华医学会第 13 次全国胸心血管外科学术会议热点解读. 中国胸心血管外科临床杂志, 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. 冠状动脉旁路移植术同期行心脏瓣膜手术的方法及疗效. 中国继续医学教育, 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.	吴昊, 肖春晖, 祝明华. 心脏机械瓣膜置换术后以国际标准化比值目标为 1.8～2.5 下华法林用量影响因素. 中国乡村医药, 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.	赵树林, 董力, 石应康, 等. 心脏瓣膜置换术后抗凝治疗自我监测的临床研究. 四川大学学报 (医学版), 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.	陈秋林, 董力, 石应康, 等. 心脏机械瓣膜置换术后不同抗凝监测模式的非随机对照研究. 中国胸心血管外科临床杂志, 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.	李涛, 赖怡, 边策, 等. 机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗对妊娠结局影响的 Meta 分析. 中国循证医学杂志, 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, 石应康. 中国人心脏瓣膜置换术后抗凝治疗数据库建设. 中国胸心血管外科临床杂志, 2013, 20(1): 3-9.
27.	张小飞, 肖亦敏, 程云阁, 等. 心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析. 中国胸心血管外科临床杂志, 2014, 21(2): 270-271.
28.	董力, 石应康, 许建屏, 等. 中国心脏瓣膜术后多中心低强度抗凝治疗注册登记及随访研究. 中华医学杂志, 2016, 96(19): 1489-1494.
29.	董力, 刘兴会, 石应康, 等. 心脏机械瓣膜置换术后妊娠妇女低强度华法林抗凝治疗 56 例. 中华胸心血管外科杂志, 2011, 27(1): 8-10.
30.	匡锋, 周新民, 尹邦良, 等. 心脏瓣膜置换术后妇女妊娠全程口服华法令抗凝观察 103 例. 中国胸心血管外科临床杂志, 2011, 18(4): 321-324.
31.	胡小平, 韩风珍, 周沫. 心脏机械瓣膜置换后妊娠期抗凝药物的使用. 中国妇幼保健, 2005, 20(20): 2661-2663.
32.	蔡杰, 张凯伦, 蒋雄刚, 等. 机械瓣置换术后妊娠期抗凝策略. 中国医师杂志, 2011, 13(5): 668-669.
33.	汪建军, 李斌, 刘陶. 风湿性心脏病术后妊娠 37 例分析. 中国实用妇科与产科杂志, 2004, 20(3): 174-175.
34.	席爱萍, 郝占平, 唐英杰, 等. VKORC1-1639A/G 基因多态性对机械心脏瓣膜置换术后妊娠期华法林抗凝效果的影响. 中国煤炭工业医学杂志, 2014, (11): 1795-1798.
35.	郑珞, 徐霞, 郑志群. 机械瓣置换术后孕期全程口服华法令抗凝 31 例临床观察.海南医学, 2013, 24(22): 3322-3324.
36.	李斌, 李玲玲. 心脏机械瓣膜置换术后妊娠与分娩分析. 中国实用医药, 2013, 8(2): 32-33.
37.	薛秀珍. 心脏换瓣术后妊娠分娩 36 例临床观察. 中国妇幼保健, 2007, 22(13): 1753-1754.
38.	古航, 胡电, 沙金燕, 等. 78 例心脏瓣膜置换术后妊娠及分娩期抗凝方案探讨. 医学临床研究, 2002, 19(12): 522-523.
39.	黄东霞, 严坤, 蔡汝文, 等. 影响心脏瓣膜置换术术后妊娠结局的多因素分析. 中国当代医药, 2013, 20(15): 19-20, 22.
40.	蒋露, 杨凡, 李永波, 等. 机械瓣置换术后妊娠妇女妊娠期间全程服用华法林对儿童体格及智力发育的影响初探. 中国循证医学杂志, 2012, 12(5): 516-519.
41.	严坤, 黄东霞, 黄夏铎. 低分子肝素钠在心脏病换瓣术后妊娠早期的应用探讨. 国际医药卫生导报, 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.	张晓红. 机械瓣膜置换术后抗凝治疗和围分娩期处理. 中华产科急救电子杂志, 2014, 3(2): 109-113.
45.	张峥, 李斌, 谭玉洁. 心脏机械瓣膜置换术后患者妊娠与分娩临床分析. 新乡医学院学报, 2012, 29(9): 709-710.

1. 石应康. 我国胸心血管外科发展现状与趋势——中华医学会第 13 次全国胸心血管外科学术会议热点解读. 中国胸心血管外科临床杂志, 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. 冠状动脉旁路移植术同期行心脏瓣膜手术的方法及疗效. 中国继续医学教育, 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. 吴昊, 肖春晖, 祝明华. 心脏机械瓣膜置换术后以国际标准化比值目标为 1.8～2.5 下华法林用量影响因素. 中国乡村医药, 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. 赵树林, 董力, 石应康, 等. 心脏瓣膜置换术后抗凝治疗自我监测的临床研究. 四川大学学报 (医学版), 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. 陈秋林, 董力, 石应康, 等. 心脏机械瓣膜置换术后不同抗凝监测模式的非随机对照研究. 中国胸心血管外科临床杂志, 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. 李涛, 赖怡, 边策, 等. 机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗对妊娠结局影响的 Meta 分析. 中国循证医学杂志, 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, 石应康. 中国人心脏瓣膜置换术后抗凝治疗数据库建设. 中国胸心血管外科临床杂志, 2013, 20(1): 3-9.
27. 张小飞, 肖亦敏, 程云阁, 等. 心脏机械瓣膜置换术后华法林低强度抗凝治疗的临床分析. 中国胸心血管外科临床杂志, 2014, 21(2): 270-271.
28. 董力, 石应康, 许建屏, 等. 中国心脏瓣膜术后多中心低强度抗凝治疗注册登记及随访研究. 中华医学杂志, 2016, 96(19): 1489-1494.
29. 董力, 刘兴会, 石应康, 等. 心脏机械瓣膜置换术后妊娠妇女低强度华法林抗凝治疗 56 例. 中华胸心血管外科杂志, 2011, 27(1): 8-10.
30. 匡锋, 周新民, 尹邦良, 等. 心脏瓣膜置换术后妇女妊娠全程口服华法令抗凝观察 103 例. 中国胸心血管外科临床杂志, 2011, 18(4): 321-324.
31. 胡小平, 韩风珍, 周沫. 心脏机械瓣膜置换后妊娠期抗凝药物的使用. 中国妇幼保健, 2005, 20(20): 2661-2663.
32. 蔡杰, 张凯伦, 蒋雄刚, 等. 机械瓣置换术后妊娠期抗凝策略. 中国医师杂志, 2011, 13(5): 668-669.
33. 汪建军, 李斌, 刘陶. 风湿性心脏病术后妊娠 37 例分析. 中国实用妇科与产科杂志, 2004, 20(3): 174-175.
34. 席爱萍, 郝占平, 唐英杰, 等. VKORC1-1639A/G 基因多态性对机械心脏瓣膜置换术后妊娠期华法林抗凝效果的影响. 中国煤炭工业医学杂志, 2014, (11): 1795-1798.
35. 郑珞, 徐霞, 郑志群. 机械瓣置换术后孕期全程口服华法令抗凝 31 例临床观察.海南医学, 2013, 24(22): 3322-3324.
36. 李斌, 李玲玲. 心脏机械瓣膜置换术后妊娠与分娩分析. 中国实用医药, 2013, 8(2): 32-33.
37. 薛秀珍. 心脏换瓣术后妊娠分娩 36 例临床观察. 中国妇幼保健, 2007, 22(13): 1753-1754.
38. 古航, 胡电, 沙金燕, 等. 78 例心脏瓣膜置换术后妊娠及分娩期抗凝方案探讨. 医学临床研究, 2002, 19(12): 522-523.
39. 黄东霞, 严坤, 蔡汝文, 等. 影响心脏瓣膜置换术术后妊娠结局的多因素分析. 中国当代医药, 2013, 20(15): 19-20, 22.
40. 蒋露, 杨凡, 李永波, 等. 机械瓣置换术后妊娠妇女妊娠期间全程服用华法林对儿童体格及智力发育的影响初探. 中国循证医学杂志, 2012, 12(5): 516-519.
41. 严坤, 黄东霞, 黄夏铎. 低分子肝素钠在心脏病换瓣术后妊娠早期的应用探讨. 国际医药卫生导报, 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. 张晓红. 机械瓣膜置换术后抗凝治疗和围分娩期处理. 中华产科急救电子杂志, 2014, 3(2): 109-113.
45. 张峥, 李斌, 谭玉洁. 心脏机械瓣膜置换术后患者妊娠与分娩临床分析. 新乡医学院学报, 2012, 29(9): 709-710.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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

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