Acenocoumarol and Pregnancy Outcome in a Patient with Mitral Valve Prosthesis: A Case Report

Stefanidis, Konstantinos; Papoutsis, Dimitrios; Loutradis, Dimitris; Antsaklis, Aris

doi:10.1159/000207449

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…Possibly, the case was a success due to optimum replacements of coumarins. [17] Vitamin K metabolism can also be disrupted by maternal medication in the 15 days before birth, which requires the administration of antenatal vitamin K (10-20 mg/day orally). If this treatment has been omitted, the intramuscular (IM) administration of 10 mg intrapartum vitamin K to the mother is recommended at the beginning of birth.…”

Section: Discussionmentioning

confidence: 99%

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report

Sagaidac¹,

Rotaru²,

Cernetchi³

2022

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Neonatal hemorrhagic syndrome, which affects several principal organs during the early neonatal period, denotes a deficiency of vitamin K and coagulation factors. This article presents the case of a patient who gave birth at term, had congenital heart disease and required several prior surgical interventions including corrected transposition of the great vessels via ventricular septal defect (VSD) repair, atrial septal defect (in childhood) and tricuspid valve replacement (6 years ago), mitral regurgitation (MR), grade I pulmonary regurgitation (PR), grade II mitral and tricuspid valve regurgitation, and grade II heart failure based on the New York Health Association (NYHA) classification. Throughout the pregnancy, the patient received large doses of anticoagulant, specifically acenocumarolum, until the moment she gave birth. The vaginal delivery was spontaneous, contrary to the recommendations given to the pregnant woman in a secondary healthcare institution. At birth, the newborn was in satisfactory condition, with 8/9 on the Apgar score. However, the newborn’s condition worsened over time, suspected of having neonatal hemorrhagic syndrome caused by medications received by the mother. Forty-eight hours after birth, the newborn died. Anticoagulant therapy cannot be regarded as 100 percent risk-free during pregnancy due to the potential for hemodynamic disorders to develop in both the mother and the unborn child. Considering the high incidence of perinatal mortality in such cases (10-30%), it is advised that a multidisciplinary team work together to inform the mother about potential complications, collaboratively determine the length of treatment with vitamin K antagonists (VKAs), develop a plan for monitoring the pregnancy, and determine which institution the mother and newborn would benefit from receiving qualified medical assistance.

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Section: Discussionmentioning

confidence: 99%

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report

Sagaidac¹,

Rotaru²,

Cernetchi³

2022

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“…The antithrombotic regimen used was acenocoumarol 2 mg/day throughout the 2nd and 3rd trimesters of pregnancy with replacement of acenocoumarol by enoxaparin sodium 60 mg twice daily (low-molecular-weight heparin -LMWH) in the 1st trimester during weeks 7-12. International normalization ratio (INR) values were kept above 2.5. At 36 weeks of gestation, acenocoumarol was substituted with unfractionated heparin and 2 days later the patient entered spontaneous premature labor and was emergently delivered via cesarean section (INR = 1.4).No coumarin embryopathy or neonatal bleeding was revealed and the postoperative course of the mother was uneventful.Possibly the case was a success due to optimum replacements of coumarins [17].…”

Section: Discussionmentioning

confidence: 99%

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report.

Sagaidac¹,

Cernetchi²,

Rotaru³

2021

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Neonatal hemorrhagic syndrome, which affects several principal organs during the early neonatal period, denotes a deficiency of vitamin K and coagulation factors, respectively.This article presents the case of a patient that gave birth at term, who had congenital heart disease and required several prior surgical interventions including corrected transposition of the great vessels via ventricular septal defect (VSD) repair, atrial septal defect (in childhood) and tricuspid valve replacement (6 years ago), mitral regurgitation (MR), grade I pulmonary regurgitation (PR), grade II mitral and tricuspid valve regurgitation, and grade II heart failure based on the New York Health Association (NYHA) classification. Throughout the pregnancy the patient administered large doses of anticoagulant, specifically Acenocumarolum, until the moment she gave birth. The vaginal delivery was spontaneous, contrary to the recommendations given to the pregnant woman in a secondary healthcare institution. At birth, the newborn was in satisfactory condition, with 8/9 on the Apgar score. However, the newborn’s condition worsened over time, suspected of having neonatal hemorrhagic syndrome caused by medications administered by the mother. Forty-eight hours after birth the newborn died.Anticoagulant therapy cannot be considered absolutely safe during pregnancy because it presents risks for the development of hemodynamic disorders, not only for the mother, but also for the newborn. In such cases, it is recommended that a multidisciplinary team work together to inform the mother about possible complications, collaboratively establish the duration of treatment with vitamin K antagonists (VKAs), establish a plan for monitoring the pregnancy and determining in which institution the mother and newborn can benefit from qualified medical assistance, taking into consideration the higher incidence of perinatal mortality in such cases (10-30%).

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Current awareness: Pharmacoepidemiology and drug safety

2010

Pharmacoepidemiology and Drug

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 23 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Antidiabetic Agents; 21 Contrast Agents; 22 Bone Conservation Agents; 23 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Acenocoumarol and Pregnancy Outcome in a Patient with Mitral Valve Prosthesis: A Case Report

Cited by 3 publications

References 45 publications

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report

Antenatal anticoagulant therapy and neonatal hemorrhagic syndrome. Case report.

Current awareness: Pharmacoepidemiology and drug safety

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