孕妇预防和治疗DVT

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1、Prevention&TreatmentofDVT/PEinPregnantWomenfromtheACCPGuidelines,9thEd.TheACCP'srecommendationclassificationsystem:•1=urecommendation”•2=“suggestiorT•A=basedonstrongevidencefromrandomizedtrials•B=moderateevidencethatmayineluderandomizedtrialsorobservationalstudies•C=weake

2、videnee,mostlyconsensusopinionLowolecularWeightHeparin(NotWarfarin)PreferredInPregnancyAsmostphysicianshopefullyknow,warfarinisteratogenic(causesbirthdefectsandmiscarriages).Forpreventionand/ortreatmentofdeepvenousthrombosis(DVT)andpulmonaryembolism(PE)inpregnantwomen,the

3、ACCPrecommendslow-molecularweightheparininsteadofwarfarin/Coumadin(Grade1B).TheoneexceptionIseehereisforpregnantwomenwithmechanicalheartvalves,forwhomtheACCPconsiderswarfarintobeacceptableasanalternativetoheparinincertainsituations(seebelow).ForWomenTakingCoumadinWhoAreTr

4、yingtoBecomePregnantTheACCPsuggestsawomantakingwarfarin/Coumadinwhoistryingtoconceiveapregnancyshouldtakefrequentpregnancytestsandswitchfromwarfarintolowmolecularweightheparin(LMWH)afterbecomingpregnant—asopposedtoswitchingfromwarfarintoLMWHwhiletryingtoconceive(Grade2C).

5、This(Grade2C)isthesoftestpossiblerecommendation/suggestion;ACCPfurtherclarifiesthatwomenwhoprefertheinconvenience,risks,andexpenseofheparininjectionsovertheriskofmiscarriageandbirthdefects(i.e.,mostwomenIknow)arewelcometoswitchtolowmolecularweightheparinwhiletryingtoconce

6、iveahealthychild.(Isthisguyevenanobstetrician?)AfterCesareans,MostWornenDon'tNeedSpecialDVT/PEProphlyaxisWomenwhohavejustundergonecaesareansectionwhoareataverageriskforDVT/PE(i.e.,thevastmajorityofwomen)shouldnotreceiveDVT/PEprophylaxis,otherthangettingoutofbedtowalkearly

7、andoften(Grade1B).WomenconsideredtobeatincreasedriskforDVT/PEaftercesareansectionaresuggestedtoreceiveprophylaxiswithlowmolecularweightheparin,or(forthosewithacontraindicationtoanticoagulation)elasticstockingsorintermittentpneumaticlegcompressiondeviceswhileinthehospital(

8、Grade2B).WomenareatincreasedriskforDVT/PEaftercesareansection,ACCPsays,arethosewithonemajorriskf