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Thromb Haemostasis:妊娠早期暴露于苯丙香豆素对妊娠结局的影响取决于治疗时间长短!

2017-05-31 xing.T MedSci原创

由此可见,苯丙香豆素及其他VKA具有胚胎毒性。这种风险似乎具有时间依赖性,出生缺陷和自发性流产的风险在治疗5周后陡增。如果产妇疾病允许的前体下,VKA治疗应在早期识别妊娠后立即转用为更安全的替代品,如肝素。

近日,血栓和凝血疾病权威杂志Thrombosis and Haemostasis上发表了一篇研究文章,这项观察性队列研究旨在明确妊娠早期使用维生素K拮抗剂(VKA)苯丙香豆素的风险,尤其是估计出生缺陷和自发性流产的风险。

研究人员将480名暴露于苯丙香豆素的孕妇与1642例既未接触VKA也未接触其他主要致畸物或毒素的孕妇进行了比较。在暴露队列中没有发生典型的华法林胚胎病。然而,主要出生缺陷的总体发病率显著增加(7.4% vs. 2.3%;调整后的比值比[ORadj]为2.14; 95%可信区间[CI]为1.4-3.4)。早期治疗终止直至五个完整的孕周的孕妇出生缺陷风险与对照队列相似(2.4% vs. 2.3%; ORadj为1.07; 95%CI为0.2-3.6)。治疗持续时间超过七周,主要出生缺陷发生率增加五倍(10.8% vs. 2.3%; ORadj为5.18; 95%CI为2.0-11.6)。

与对照队列相比,暴露组自发性流产(SAB)的总体风险分别为17.5% vs. 38.0%(HRadj为2.9; 95%CI为2.2-3.9)。治疗持续时间对SAB的风险也有显著影响(暴露每增加一周时间HRadj为1.12;95%CI为1.01-1.25)。

由此可见,苯丙香豆素及其他VKA具有胚胎毒性。这种风险似乎具有时间依赖性,出生缺陷和自发性流产的风险在治疗5周后陡增。如果产妇疾病允许的前体下,VKA治疗应在早期识别妊娠后立即转用为更安全的替代品,如肝素。

原始出处:

E. Hüttel,et al. Pregnancy outcome of first trimester exposure to the vitamin K antagonist phenprocoumon depends on duration of treatment.Thrombosis and Haemostasis.2017. https://doi.org/10.1160/TH16-11-0838

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    2017-10-04 mhm289
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    2018-01-25 changfy
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  7. 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createdName=tanxingdoctor, createdTime=Wed May 31 20:56:02 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-06-01 tanxingdoctor

    学习啦谢谢分享

    0

  8. 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createdName=tanxingdoctor, createdTime=Wed May 31 20:56:02 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-05-31 惠映实验室

    对于妊娠所用到的药物,应衡量其利弊?

    0

  9. 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createdName=tanxingdoctor, createdTime=Wed May 31 20:56:02 CST 2017, time=2017-05-31, status=1, ipAttribution=)]
    2017-05-31 tanxingdoctor

    学习啦谢谢分享

    0

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