VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
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DOI：
10.1378/chest.11-2300
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发表时间：
2012-02-01
期刊：
影响因子：
9.6
通讯作者：
Vandvik, Per Olav
中科院分区：
文献类型：
--
作者：
Bates, Shannon M.;Greer, Ian A.;Vandvik, Per Olav
背景：在妊娠期间使用抗凝治疗是具有挑战性的，因为胎儿和母体的潜在并发症。本指南侧重于静脉血栓栓塞和血栓形成的管理以及妊娠期间抗血栓药物的使用。方法：本指南的方法遵循抗血栓治疗和预防血栓形成指南的发展方法：抗血栓治疗和预防血栓形成，第9版：美国胸科医师学会循证临床实践指南。结果：我们推荐使用低分子肝素来预防和治疗孕妇静脉血栓栓塞（VTE），而不是使用未分离肝素（1B级）。对于急性静脉血栓栓塞的孕妇，我们建议抗凝剂至少在产后6周继续使用（治疗时间至少为3个月），而不是使用更短的治疗时间（2C级）。对于符合抗磷脂抗体（APLA）综合征的实验室标准和基于三次或三次以上流产史的临床APLA标准的妇女，我们建议产前给予预防性或中等剂量的未分离肝素或预防性低分子肝素联合低剂量阿司匹林（75- 100mg /d），而不是不治疗（1B级）。对于有遗传性血栓形成和妊娠并发症史的女性，我们建议不要使用抗血栓预防药物（2C级）。对于两次或两次以上流产但没有APLA或血栓形成的女性，我们不建议抗血栓预防（1B级）。结论：本指南中的大多数建议都是基于观察性研究和其他人群的推断。迫切需要在这一人群中进行适当设计的研究。
Background: The use of anticoagulant therapy during pregnancy is challenging because of the potential for both fetal and maternal complications. This guideline focuses on the management of VTE and thrombophilia as well as the use of antithrombotic agents during pregnancy.Methods: The methods of this guideline follow the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.Results: We recommend low-molecular-weight heparin for the prevention and treatment of VTE in pregnant women instead of unfractionated heparin (Grade 1B). For pregnant women with acute VTE, we suggest that anticoagulants be continued for at least 6 weeks postpartum (for a minimum duration of therapy of 3 months) compared with shorter durations of treatment (Grade 2C). For women who fulfill the laboratory criteria for antiphospholipid antibody (APLA) syndrome and meet the clinical APLA criteria based on a history of three or more pregnancy losses, we recommend antepartum administration of prophylactic or intermediate-dose unfractionated heparin or prophylactic low-molecular-weight heparin combined with low-dose aspirin (75-100 mg/d) over no treatment (Grade 1B). For women with inherited thrombophilia and a history of pregnancy complications, we suggest not to use antithrombotic prophylaxis (Grade 2C). For women with two or more miscarriages but without APLA or thrombophilia, we recommend against antithrombotic prophylaxis (Grade 1B).Conclusions: Most recommendations in this guideline are based on observational studies and extrapolation from other populations. There is an urgent need for appropriately designed studies in this population.