Anticoagulation Regimens During Pregnancy in Patients With Mechanical Heart Valves: A Systematic Review and Meta-analysis

Management of direct oral anticoagulants in women of childbearing potential: guidance from the SSC of the ISTH: reply

“…There were two coumarin embryopathies (0.6%; both phenprocoumon), both of which were in women in whom heparin substitution started after the 6th gestational week [8]. This, together with the other literature, supports the idea that the risk of teratogenicity with VKAs is extremely low provided that the women are switched to LMWH before 6 weeks of gestation [6,7]. In addition, warfarin and other VKAs have a head start of > 60 years over DOACs [4][5][6][7][8][9] with regard to the acquisition of such information; we simply do not have sufficient information about the latter.…”

“…Secondly, some drugs might also affect MPV levels, including statins and anticoagulant drugs [6,7]. As there were 27.2% of patients with cardiovascular diseases and 15.2% of patients with previous acute coronary syndrome, the usage of statins and anticoagulant drugs might be of a high ratio.…”

“…Desborough et al allude to the teratogenicity of VKAs [1,[4][5][6][7]. The most substantive data on this are from a multicenter (n = 12), observational, prospective study by the European Network of Teratology Information Service, an organization of services that offer counseling on drug risks during pregnancy.…”

Management of direct oral anticoagulants in women of childbearing potential: guidance from the SSC of the ISTH: comment

“…The rate of these anomalies is difficult to determine, with differing incidence rates being seen between cohorts [2-4]. Switching to LMWH before 6 weeks of gestation dramatically reduces the risk or embryopathy [4,5], although this relies on detecting pregnancy in a timely manner.We recommend reconsideration of the recommendation in this guideline that women who are taking a DOAC (with a theoretical risk of teratogenicity) should move to a VKA (with a known risk of teratogenicity) when they plan for a child. We feel that it would be safer to continue with the DOAC and switch to LMWH at the first sign of pregnancy, before 6 weeks of gestation.…”

“…The rate of these anomalies is difficult to determine, with differing incidence rates being seen between cohorts [2-4]. Switching to LMWH before 6 weeks of gestation dramatically reduces the risk or embryopathy [4,5], although this relies on detecting pregnancy in a timely manner.…”