Anticoagulant management of pregnant women with mechanical heart valve replacement during perioperative period

Bian, Ce; Qi, Xiaorong; Li, Li; Zhao, Jitong; Liu, Xinghui

doi:10.1007/s00404-015-3768-0

Cited by 9 publications

(21 citation statements)

References 16 publications

(16 reference statements)

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“…After duplicate removal, 247 studies were identified through database search and screened by title and abstract. A total of 37 studies were finally included 1 2 3 5 8 10 12 13 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 ( Table 1 ). In 22 of the included studies, data were retrospectively collected, 6 10 12 13 17 18 19 20 21 23 24 25 26 28 32 36 37 38 40 41 42 43 44 whereas 15 studies collected data prospectively.…”

Section: Resultsmentioning

confidence: 99%

Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and Meta-Analysis

Jakobsen

Larsen

Fuglsang

et al. 2022

Semin Thromb Hemost

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Anticoagulant therapy is essential in pregnant women with mechanical heart valves to prevent valve thrombosis. The risk of bleeding complications in these patients has not gained much attention. This systematic review and meta-analysis investigate the prevalence of bleeding peri-partum and post-partum in women with mechanical heart valves and also investigate whether bleeding risk differed across anticoagulant regimens or according to delivery mode. The present study was conducted according to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Studies reporting bleeding prevalence in pregnant women with mechanical heart valves receiving anticoagulant therapy were identified through PubMed and Embase on December 08, 2021. Data on bleeding complications, delivery mode, and anticoagulation therapy were extracted. A total of 37 studies were included, reporting 423 bleeding complications in 2,508 pregnancies. A meta-analysis calculated a pooled prevalence of 0.13 (95% confidence interval [CI]: 0.09–0.18) bleeding episodes per pregnancy across anticoagulant regimens. The combination of unfractionated heparin (UFH) and vitamin K antagonist (VKA) and single VKA therapy showed the lowest risk of bleeding (8 and 12%). Unexpectedly, the highest risk of bleeding was found in women receiving a combination of low-molecular-weight-heparin (LMWH) and VKA (33%) or mono-therapy with LMWH (22%). However, this could be dose related. No difference in bleeding was found between caesarean section versus vaginal delivery (p = 0.08). In conclusion, bleeding episodes are common during pregnancy in women with mechanical heart valves receiving anticoagulant therapy. A combination of UFH and VKA or VKA monotherapy showed the lowest risk of bleeding.

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Section: Resultsmentioning

confidence: 99%

Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and Meta-Analysis

Jakobsen

Larsen

Fuglsang

et al. 2022

Semin Thromb Hemost

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“…The overall incidence of prosthetic valve thrombosis in mitral or aortic position at any time is 0.5-6% in developing countries, being the highest in mitral position, while in developed countries the prevalence is 0.3-1.3% [1][2][3][4]. Patient-related risk factors for prosthetic valve thrombosis are: inadequate anticoagulation, left ventricular dysfunction, atrial fibrillation, pregnancy (hypercoagulability status), infection, early postoperative period, among others [1][2][3][5][6][7][8], many of which were observed in our case clearly because the patient had inadequate anticoagulation levels over the follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery has high-risk factors because it is a reintervention, most often performed under emergency conditions. On the other hand, fibrinolysis carries important risks of bleeding, systemic embolism, and recurrent thrombosis that are higher than after surgery [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Fourth mitral valve replacement in a 15-year span in a woman of childbearing age

Rodríguez-Chávez

Raymundo-Martínez

Gopar‐Nieto

2018

Journal of Cardiology Cases

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“…Furthermore, an NMA can estimate the rank of these treatments 23 2425 and nine observational studies)26–34 in recent years were not included in these studies, which reduced trustworthiness and statistical power of these studies. Finally, some subgroups of anticoagulation treatments (eg, different VKAs and heparin doses, different combinations of sequential treatments, and type, location and number of MHVs, etc) were not considered in these studies, which led to the lack of results of effectiveness and safety by comparing these subgroups.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation regimens during pregnancy in patients with mechanical heart valves: a protocol for a systematic review and network meta-analysis

Zou

et al. 2020

BMJ Open

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IntroductionPregnancy in patients with mechanical heart valves (MHVs) is associated with high maternal complications and fetal complications.Anticoagulation treatments serve to decrease their venous clotting risk. Although some anticoagulation regimens have been used for patients during pregnancy with MHVs, no one is definitively superior among different regimens in recent studies. For a better understanding of the clinical treatment which anticoagulation regimen is more effective and safer during the pregnancy in patients with MHVs, a Bayesian network meta-analysis is necessary.Methods and analysisThis protocol has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Related studies until April 2019 will be searched in the following databases: PubMed, Embase,SinoMed and the using the OVID interface to search for evidence-based medicine reviews. A clinical trial registry (www.ClinicalTrials.gov) was also searched for unpublished trials. Both experimental studies (randomised clinical trials) and observational studies (cohort studies, case–control studies and case series studies) will be included in this study. Quality assessment will be conducted using Cochrane Collaboration’s tool or Newcastle-Ottawa Scale based on their study designs. The primary outcomes of interest will be the frequencies of serious maternal and fetal events. The additional outcomes of interest will be adverse maternal events, mode of delivery and adverse fetal events. Pairwise and network meta-analysis will be conducted using R (V.3.4.4, R Foundation for Statistical Computing, Vienna, Austria) and Stata (V.14, StataCorp). The ranking probabilities will be estimated at each possible rank for each anticoagulation regimen using the surface under the cumulative ranking curve. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed.Ethics and disseminationEither ethics approval or patient consent is not necessary, because this study will be based on literature. The results of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019130659

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Anticoagulant management of pregnant women with mechanical heart valve replacement during perioperative period

Cited by 9 publications

References 16 publications

Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and Meta-Analysis

Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and Meta-Analysis

Fourth mitral valve replacement in a 15-year span in a woman of childbearing age

Anticoagulation regimens during pregnancy in patients with mechanical heart valves: a protocol for a systematic review and network meta-analysis

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