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》

作者：

李涛 ¹ , 赖怡 ² , 边策 ¹ ,  刘兴会 ¹

1. 四川大学华西第二医院妇产科 (成都 610041)2. 四川大学华西第二医院实验中心;

关键词：

抗凝治疗华法林肝素妊娠机械心脏瓣膜 Meta分析

DOI：

10.7507/1672-2531.20080010

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　比较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的影响。
方法　采用Cochrane系统评价方法，检索MEDLINE（1980～2007）、EMbase（1984～2004）、CBM（1980～2007）、CNKI（1994～2007）等电子资料库，由2名评价者共同评价纳入研究质量，对同质研究进行Meta分析。
结果　共纳入7个研究、469例患者、629孕次；其中5篇为回顾性研究，2篇为前瞻性研究。机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗与法华林治疗比较，母体不良结局发生率差异无统计学意义；胎儿不良结局发生率差异也无统计学意义。
结论　目前的研究证据表明，机械心脏瓣膜置换术后孕早期肝素替代华法林抗凝治疗并不能减少胎儿不良结局发生率。整个孕期口服小剂量华法林抗凝治疗，生产前停华法林改为肝素是可行的方案，但需与患者充分沟通。

引用本文： 李涛,赖怡,边策,刘兴会. 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, 08(1): 42-48. doi: 10.7507/1672-2531.20080010 复制

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.	雪莲, 郭超华, 周文武, 等. 机械心瓣膜置换术后妊娠低强度抗凝治疗的临床观察. 中国医师杂志, 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. 雪莲, 郭超华, 周文武, 等. 机械心瓣膜置换术后妊娠低强度抗凝治疗的临床观察. 中国医师杂志, 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.

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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

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《中国循证医学杂志》

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

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