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》

作者：

李濤 ¹ , 賴怡 ² , 邊策 ¹ ,  劉興會 ¹

1. 四川大學華西第二醫院婦產科 (成都 610041)2. 四川大學華西第二醫院實驗中心;

關鍵詞：

抗凝治療華法林肝素妊娠機械心臟瓣膜 Meta分析

DOI：

10.7507/1672-2531.20080010

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　比較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的影響。
方法　采用Cochrane系統評價方法，檢索MEDLINE（1980～2007）、EMbase（1984～2004）、CBM（1980～2007）、CNKI（1994～2007）等電子資料庫，由2名評價者共同評價納入研究質量，對同質研究進行Meta分析。
結果　共納入7個研究、469例患者、629孕次；其中5篇為回顧性研究，2篇為前瞻性研究。機械心臟瓣膜置換術后孕早期肝素替代華法林抗凝治療與法華林治療比較，母體不良結局發生率差異無統計學意義；胎兒不良結局發生率差異也無統計學意義。
結論　目前的研究證據表明，機械心臟瓣膜置換術后孕早期肝素替代華法林抗凝治療并不能減少胎兒不良結局發生率。整個孕期口服小劑量華法林抗凝治療，生產前停華法林改為肝素是可行的方案，但需與患者充分溝通。

引用本文： 李濤,賴怡,邊策,劉興會. 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, 08(1): 42-48. doi: 10.7507/1672-2531.20080010 復制

1.	North RA, Sadler L, Stewart AW, et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation, 1999, 99: 2669-2676.
2.	Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects, 1965, 12: 133-140.
3.	Ginsberg JS, Hirsh J. Use of antithrombotic agents duringpregnancy. Chest, 1998, 114(5 uppl): 524S-30S.
4.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA, 2000, 283(15): 2008-2012.
5.	Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare, 2004, 10(6): 318-324.
6.	Adil AM, Lawati Al, Venkitraman M, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. European Journal of Cardio-thoracic Surgery, 2002, 22: 223-227.
7.	Anwar HN, Hobeika EM. Pregnancy outcome in women with prosthetic heart valves. American Journal of Obstetrics and Gynecology, 2004, 191: 1009-1013.
8.	Muhammad A, Amitabh S, et al. Anticoagulation in patienta with mechanical valves during pregnancy. Asian Cardiovasc Throrac Ann, 2005, 13: 30-33.
9.	Meschengieser SS, Fondevila CG, Santarelli MT. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart, 1999, 82(1): 23-26.
10.	Ashour ZA, Hesham Abdel Fattah, et al. Outcome of Pregnancy in Women with Mechanical Valves. Tex Heart Inst J, 2000, 27: 240-245.
11.	雪蓮, 郭超華, 周文武, 等. 機械心瓣膜置換術后妊娠低強度抗凝治療的臨床觀察. 中國醫師雜志, 2003, 5(2): 215-216.
12.	Kim KH, Jeong DS, Ahn H. Anticoagulation in pregnant women with a bileaflet mechanical cardiac valve replacement. Heart Surg Forum, 2007, 10(4): 267-270.
13.	ChanWS, 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.
14.	Vitale N, De Feo M, De Santo LS, et al. Anticoagulation for prosthetid heart valves during pregnancy: the importance of warfarin daily dose. Eur J Cardio- thoracic Surg, 2002, 21(3): 656-657.
15.	Vitale N, De Feo M, Cotrufo M, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33: 1637-1641.
16.	Cotrufo M, De Feo M, et al. Risk of Warfarin During Pregnancy With Mechanical Valve Prostheses. Obestet Gynecol, 2002, 99(1): 35-40.
17.	Elkayam U. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol, 1996, 27(18): 1704-1706.
18.	Massel D, Stephen H. Risks and benefits of adding anti - platelet therapy to warfarin among patients with prosthetic heart valves: a meta- analysis. Journal of the American College of Cardiology,? 2001, 37: 569-578.
19.	Salazar E, Izaguirre R, Verdejo J, et al. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol, 1996, 27: 1698-1703.
20.	Jilma B, Kamath S, Lip GY. Antithrombotic therapy in special circumstances. I- pregnancy and cancer. BMJ, 2003, 326: 37-40(4 Jan).
21.	Sanson BJ, Lensing AW, PrisMH, et al. Safety of low - molecular - weightheparin in pregnancy: a systematic review. Thromb Haemost, 1999, 81: 668-672.
22.	Alexander D, Makatsaria, Victoria O, et al. Use of the low - molecular -weight heparin nadroparin during pregnancy. A review. Curr Med ResOpin, 2003, 19(1): 4-12.
23.	Leyh RG, Fischer S, Ruhparwar A, et al. Anticoagrlation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative? European Journal of Cardio-thoracic Surgery, S2002, 21(12): 577-579.
24.	Gin JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest, 2001, 119: 122s-131s.
25.	Blickstein D, Blickstein L. The risk of fetal loss associated with warfarin anticoagulation. Int J Gynaecol Obstet, 2002, 78: 221-225.

1. North RA, Sadler L, Stewart AW, et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation, 1999, 99: 2669-2676.
2. Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects, 1965, 12: 133-140.
3. Ginsberg JS, Hirsh J. Use of antithrombotic agents duringpregnancy. Chest, 1998, 114(5 uppl): 524S-30S.
4. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA, 2000, 283(15): 2008-2012.
5. Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare, 2004, 10(6): 318-324.
6. Adil AM, Lawati Al, Venkitraman M, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. European Journal of Cardio-thoracic Surgery, 2002, 22: 223-227.
7. Anwar HN, Hobeika EM. Pregnancy outcome in women with prosthetic heart valves. American Journal of Obstetrics and Gynecology, 2004, 191: 1009-1013.
8. Muhammad A, Amitabh S, et al. Anticoagulation in patienta with mechanical valves during pregnancy. Asian Cardiovasc Throrac Ann, 2005, 13: 30-33.
9. Meschengieser SS, Fondevila CG, Santarelli MT. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart, 1999, 82(1): 23-26.
10. Ashour ZA, Hesham Abdel Fattah, et al. Outcome of Pregnancy in Women with Mechanical Valves. Tex Heart Inst J, 2000, 27: 240-245.
11. 雪蓮, 郭超華, 周文武, 等. 機械心瓣膜置換術后妊娠低強度抗凝治療的臨床觀察. 中國醫師雜志, 2003, 5(2): 215-216.
12. Kim KH, Jeong DS, Ahn H. Anticoagulation in pregnant women with a bileaflet mechanical cardiac valve replacement. Heart Surg Forum, 2007, 10(4): 267-270.
13. ChanWS, 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.
14. Vitale N, De Feo M, De Santo LS, et al. Anticoagulation for prosthetid heart valves during pregnancy: the importance of warfarin daily dose. Eur J Cardio- thoracic Surg, 2002, 21(3): 656-657.
15. Vitale N, De Feo M, Cotrufo M, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33: 1637-1641.
16. Cotrufo M, De Feo M, et al. Risk of Warfarin During Pregnancy With Mechanical Valve Prostheses. Obestet Gynecol, 2002, 99(1): 35-40.
17. Elkayam U. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol, 1996, 27(18): 1704-1706.
18. Massel D, Stephen H. Risks and benefits of adding anti - platelet therapy to warfarin among patients with prosthetic heart valves: a meta- analysis. Journal of the American College of Cardiology,? 2001, 37: 569-578.
19. Salazar E, Izaguirre R, Verdejo J, et al. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol, 1996, 27: 1698-1703.
20. Jilma B, Kamath S, Lip GY. Antithrombotic therapy in special circumstances. I- pregnancy and cancer. BMJ, 2003, 326: 37-40(4 Jan).
21. Sanson BJ, Lensing AW, PrisMH, et al. Safety of low - molecular - weightheparin in pregnancy: a systematic review. Thromb Haemost, 1999, 81: 668-672.
22. Alexander D, Makatsaria, Victoria O, et al. Use of the low - molecular -weight heparin nadroparin during pregnancy. A review. Curr Med ResOpin, 2003, 19(1): 4-12.
23. Leyh RG, Fischer S, Ruhparwar A, et al. Anticoagrlation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative? European Journal of Cardio-thoracic Surgery, S2002, 21(12): 577-579.
24. Gin JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest, 2001, 119: 122s-131s.
25. Blickstein D, Blickstein L. The risk of fetal loss associated with warfarin anticoagulation. Int J Gynaecol Obstet, 2002, 78: 221-225.

《中國循證醫學雜志》

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

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

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

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料