Survey on anticoagulant therapy in pregnant women with cardiovascular disease

Abstract

Abstract: In recent years, extensive application of anticoagulation drugs benefits more and more patients suffering from thromboembolic events. However, the anticoagulants have benefits and risks, which like a double-edged sword. How to balance the prevention of thromboembolism and the bleeding problems and optimize the treatments might be a serious problem for clinical physicians. Considering the women with pregnancy, anticoagulant therapy is a complex and challenging problem. According to the latest guidelines and recent studies on pregnant women with anticoagulant therapy, this review summarized anticoagulant therapies for the pregnant women with cardiovascular diseases, which includes the hypercoagulable states of pregnant women, the main types of anticoagulant drugs and clinical application.

Key words: pregnancy, cardiovascular disease, anticoagulation, Warfarin, Heparin

CLC Number:

R543
714.252

XIONG Qin-mei, HONG Kui. Survey on anticoagulant therapy in pregnant women with cardiovascular disease[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(2): 223-227.

References

[1] Chen H, Zhou L, Meng L, et al. Coagulation and prothrombotic state parameters: a clinical analysis during early pregnancy[J]. Ir J Med Sci, 2011, 180(4): 813-817.
[2] Hui C, Lili M, Libin C, et al. Changes in coagulation and hemodynamics during pregnancy: a prospective longitudinal study of 58 cases[J]. Arch Gynecol Obstet, 2012, 285(5): 1231-1236.
[3] Choi JW, Pai SH. Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy[J]. Ann Hematol, 2002, 81(11): 611-615.
[4] Uchikova EH, Ledjev II. Changes in haemostasis during normal pregnancy[J]. Eur J Obstet Gynecol Reprod Biol, 2005, 119(2): 185-188.
[5] Szecsi PB, Jorgensen M, Klajnbard A, et al. Haemostatic reference intervals in pregnancy[J]. Thromb Haemost, 2010, 103(4): 718-727.
[6] Wickstrom K, Edelstam G, Lowbeer CH, et al. Reference intervals for plasma levels of fibronectin, von Willebrand factor, free protein S and antithrombin during third-trimester pregnancy[J]. Scand J Clin Lab Invest, 2004, 64(1): 31-40.
[7] James AH, Jamison MG, Biswas MS, et al. Acute myocardial infarction in pregnancy: a United States population-based study[J]. Circulation, 2006, 113(12): 1564-1571.
[8] Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study[J]. Ann Intern Med, 2005, 143(10): 697-706.
[9] James AH, Jamison MG, Brancazio LR, et al. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality[J]. Am J Obstet Gynecol, 2006, 194(5): 1311- 1315.
[10] Regitz-Zagrosek V, Blomstrom LC, Borghi C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2011, 32(24): 3147-3197.
[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]. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
[12] Bian C, Wei Q, Liu X. Influence of heart-valve replacement of warfarin anticoagulant therapy on perinatal outcomes[J]. Arch Gynecol Obstet, 2012, 285(2): 347-351.
[13] 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[J]. Chest, 2012, 141(2 Suppl): e691S-e736S.
[14] Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature[J]. Arch Intern Med, 2000, 160(2): 191-196.
[15] Abildgaard U, Sandset PM, Hammerstrom J, et al. Management of pregnant women with mechanical heart valve prosthesis: thromboprophylaxis with low molecular weight heparin[J]. Thromb Res, 2009, 124(3): 262-267.
[16] Hameed A, Akhter MW, Bitar F, et al. Left atrial thrombosis in pregnant women with mitral stenosis and sinus rhythm[J]. Am J Obstet Gynecol, 2005, 193(2): 501-504.
[17] Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)[J]. Europace, 2010, 12(10): 1360-1420.
[18] Healey JS, Hart RG, Pogue J, et al. Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE-W)[J]. Stroke, 2008, 39(5): 1482-1486.
[19] 黄晓晖,王夏芹,唐海沁,等.华法林和阿司匹林联用在大鼠体内的药代动力学研究[J].中国临床药理学与治疗学,2012,17(2):189-194.