因分娩而中断抗凝治疗的机械心脏瓣膜孕妇的出血和血栓栓塞结局--病例系列。

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Lily Aboud, Helen Tanner, William Parsonage, Karin Lust, Leonie Callaway
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引用次数: 0

摘要

背景:抗凝治疗可预防机械心脏瓣膜患者的血栓形成和血栓栓塞事件。分娩前后衔接抗凝是一项独特的挑战。很少有回顾性综述或病例系列研究围产期衔接抗凝治疗的结果。目的:回顾围产期和产后抗凝管理,重点关注产后并发症:设计:病例系列,单中心:主要结局指标:产中和产后出血、血栓形成、血栓栓塞并发症、心脏事件、再入院和产妇死亡:共有 18 名产妇,23 次分娩。其中 16 例为剖腹产(70%)。14名产妇(61%)经历了至少一次严重的出血性并发症,1名产妇需要进行围产期子宫切除术,1名产妇出现心房颤动,1名产妇出现瓣膜血栓栓塞并发症。没有产妇脑血栓或产妇死亡的记录:结论:患有机械心脏瓣膜的产妇在接受桥接抗凝治疗时,产妇发病率很高。大多数产后出血并发症与产后第一周内桥接性输注非分数肝素有关。桥接抗凝治疗的做法差异很大。需要不断汇集数据,为产后抗凝管理的循证指南提供依据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Haemorrhagic and thromboembolic outcomes in pregnant patients with mechanical heart valves who undergo interruption of anticoagulation for birth - A case series.

Background: Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.

Aims: Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.

Materials and methods: Design: case series, single centre.

Setting: Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022.

Population: all pregnant women with mechanical heart valves (any type) who birthed.

Main outcome measures: intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.

Results: There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.

Conclusions: Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.

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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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