Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Wang, Jing; Li, Kangqi; Li, Hongyan; Zhu, Weiwei; Sun, Hui; Lu, Congxiao

doi:10.1111/1755-5922.12292

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…The usual treatment choice for prosthetic mechanical valves is warfarin. However, due to the possible teratogenicity of the treatment, it is an unsuitable choice during pregnancy 45 . Based on Elkayam and Goland recommendations 46 and a recent metanalysis by Jacobson et al 47 on the safety of low molecular weight heparin (LMWH) in pregnancy, treatment with LMWH can be administered for the patient.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the possible teratogenicity of the treatment, it is an unsuitable choice during pregnancy. 45 Based on Elkayam and Goland recommendations 46 and a recent metanalysis by Jacobson et al 47 on the safety of low molecular weight heparin (LMWH) in pregnancy, treatment with LMWH can be administered for the patient. Considering the presented case, the patient was readmitted in Week 12 of the pregnancy, and the LMWH treatment was changed to warfarin.…”

Section: Medication Challengesmentioning

confidence: 99%

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Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles

Ayati

Sarraf

Fallah

et al. 2022

Journal of Cardiac Surgery

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Introduction: Acute-type aortic dissection (AD) during pregnancy is considered a rare and potentially fatal complication for both mother and fetus. Although the definite treatment for an acute-type AD is considered to be open-heart surgery, the decision to perform such a surgery during pregnancy requires a multidisciplinary approach and carries significant risks.Methods: In the present review of the literature, we have discussed various challenges in the management of acute-type AD during pregnancy, including therapeutic approaches, choosing the preferred imaging modalities, surgical techniques, and medication challenges. We have also reported an 8-week pregnant woman with Marfan syndrome who presented with chest pain and was diagnosed with acute AD. Results:The patient underwent a Bentall operation and was discharged in good condition with her fetus alive. The medical team's various decisions during preoperative, operative, and postoperative treatments were discussed.Conclusions: Type A AD is considered infrequent in the second and third trimester of pregnancy and rare in the first trimester. Performing a CMR study without contrast in stable patients can help evaluate the extension of the flap. Urgent surgery in the hands of a skilled surgeon may prove lifesaving for the mother while maximizing the likelihood of preserving the fetus.

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Section: Discussionmentioning

confidence: 99%

Section: Medication Challengesmentioning

confidence: 99%

Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles

Ayati

Sarraf

Fallah

et al. 2022

Journal of Cardiac Surgery

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“…while its teratogenic effects may be overestimated. In the same time, heparin does not provide better fetal outcomes as it is associated with severe adverse maternal outcomes, including mortality [17].…”

Section: Discussionmentioning

confidence: 99%

Is Oral Anticoagulant with High dose in Pregnant Women with Prosthetic Mechanical Valve Effective and Safe?

Tahlawi

Alanwar

Elnahal

et al. 2020

Zagazig University Medical Journal

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Background: The management of women with prothetic valves During pregnancy remains challenging. Anticoagulation in these subgroups has many controversies. We aim to evaluate the safe dose of oral anticoagulant in pregnant women with mechanical valve prosthesis in first trimester. Methods: Pregnant ladies with well functioning prothetic valves were enrolled. Patients were divided into 3 groups: Group A took oral anticoagulant < 5 mg warfarin with therapeutic INR. Group B took low molecular weight heparin (LMWH) twice daily and monitoring is done every week by antifactor Xa 4-6 hours post-injection to keep about 1 IU/ml. Group C took oral anticoagulant in dose > 5 mg warfarin to reach therapeutic INR. Results: There was significant difference between groups in vaginal bleeding and abortion, with more bleeding and abortion in group B using LMWH. There was a high rate of malfunction valve about 19.9% in group B, but no reported cases of malfunction valve in the other both groups using warfarin. Conclusion: Warfarin with dose > 5 mg in pregnant women with mechanical prosthetic valve is as safe for mother and baby as warfarin with dose < 5 mg. Both regimens are safer than LMWH.

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“…Warfarin is the rst choice of anticoagulant drugs for most non-pregnant MPHV patients. And the anticoagulant effect of it in pregnant women is also signi cantly better than heparin [5,9,10], but it has side effects on the fetus. In the comparison of the three anticoagulation methods in this study, the warfarin group had the lowest live birth rate (29.17%) and the highest stillbirth rate (23.96%), mainly related to warfarin passing through the placenta, which is likely to cause miscarriage and stillbirth [9,11,12].…”

Section: Discussionmentioning

confidence: 99%

Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

Zhao

Yang

et al. 2021

Preprint

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Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, 13 in the sequential treatment group. There are 27 cases of spontaneous abortion, 3 cases of stillbirth, 56 live births and 51 artificial abortion. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with worse heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.

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Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Abstract: The present meta-analysis indicated that warfarin can provide better protection for the mother and the teratogenic effects may be overestimated. Heparin does not ensure better fetal outcomes as it is associated with severe adverse maternal outcomes, including mortality.

Cited by 11 publications

References 16 publications

Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles

Aortic dissection in the first trimester; is it a dead end? A narrative review of recent articles

Is Oral Anticoagulant with High dose in Pregnant Women with Prosthetic Mechanical Valve Effective and Safe?

Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

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