孕妇预防和治疗DVT.doc

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1、Prevention&TreatmentofDVT/PEinPregnantWomenfromthe ACCPGuidelines,9thEd.TheACCP’srecommendationclassificationsystem:·1=“recommendation”·2=“suggestion”·A=basedonstrongevidencefromrandomizedtrials·B=moderateevidencethatmayincluderandomizedtrialsorobservationalstudies·C=weakevidence,mostly

2、consensusopinionLow-MolecularWeightHeparin(NotWarfarin)PreferredInPregnancyAsmostphysicianshopefullyknow,warfarinisteratogenic(causesbirthdefectsandmiscarriages).Forpreventionand/ortreatmentofdeepvenousthrombosis(DVT)andpulmonaryembolism(PE)inpregnantwomen,theACCPrecommendslow-molecular

3、weightheparininsteadofwarfarin/Coumadin(Grade1B).TheoneexceptionIseehereisforpregnantwomenwithmechanicalheartvalves,forwhomtheACCPconsiderswarfarintobeacceptableasanalternativetoheparinincertainsituations(seebelow).ForWomenTakingCoumadinWhoAreTryingtoBecomePregnantTheACCPsuggestsawomant

4、akingwarfarin/Coumadinwhoistryingtoconceiveapregnancyshouldtakefrequentpregnancytestsandswitchfromwarfarintolowmolecularweightheparin(LMWH)afterbecomingpregnant—asopposedtoswitchingfromwarfarintoLMWHwhiletryingtoconceive(Grade2C).This(Grade2C)isthesoftestpossiblerecommendation/suggestio

5、n;ACCPfurtherclarifiesthatwomenwhoprefertheinconvenience,risks,andexpenseofheparininjectionsovertheriskofmiscarriageandbirthdefects(i.e.,mostwomenIknow)arewelcometoswitchtolowmolecularweightheparinwhiletryingtoconceiveahealthychild.(Isthisguyevenanobstetrician?)AfterCesareans,MostWomenD

6、on’tNeedSpecialDVT/PEProphlyaxisWomenwhohavejustundergonecaesareansectionwhoareataverageriskforDVT/PE(i.e.,thevastmajorityofwomen)shouldnotreceiveDVT/PEprophylaxis,otherthangettingoutofbedtowalkearlyandoften(Grade1B).WomenconsideredtobeatincreasedriskforDVT/PEaftercesareansectionare sug

7、gested toreceiveprophylaxiswith lowmolecularweightheparin,or(forthosewithacontraindicationtoanticoagulation)elasticstockingsorintermittentpneumaticlegcompressiondeviceswhileinthehospital(Grade2B).WomenareatincreasedriskforDVT/PEaftercesareansection,ACCPsays,arethosewith onemajo