Fetal intraventricular haemorrhage and maternal warfarin

Ville, Y.; Jenkins, Erin; Shearer, Martin J.; Hemley, H.; Vasey, D. P.; Layton, Mark; Nicolaides, Kypros H.

doi:10.1016/0140-6736(93)91037-m

Cited by 44 publications

(22 citation statements)

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“…There are reports of multiple congenital abnormalities when warfarin is used between six and twelve weeks of gestation 7 , the exact incidence of which is uncertain. There are also reports of fetal intraventricular haemorrhage, microcephaly, cataracts, blindness and mental retardation when utilized during the second or third trimester 8 . The fetus is susceptible to the risk of haemorrhage due to physiologically low concentrations in fetal blood of the vitamin K dependent procoagulant factors.…”

Section: Discussionmentioning

confidence: 99%

Thromboembolism in pregnant women with mechanical prosthetic heart valves anticoagulated with low molecular weight heparin

Roberts

Ross

Flint

et al. 2001

BJOG

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A 33 year old woman had undergone a mechanical prosthetic (Starr-Edwards) mitral valve replacement for valvular damage due to rheumatic heart disease, having had three spontaneous vaginal deliveries prior to her cardiac surgery. She conceived while on warfarin and was converted at six weeks of gestation to tinzaparin treatment dose (175 units/kg) by once daily subcutaneous injection; anti-Xa levels were not monitored. She presented at 26 weeks of gestation with a right-sided hemiplegia and dysphasia. A CT scan revealed a left parietal lobe infarct.She was treated initially with adjusted dose unfractionated heparin, maintaining activated partial thromboplastin time of 2.0 to 2.5 times the control. She was subsequently switched to warfarin and aspirin (150 mg/ d). She made a satisfactory recovery and continued on warfarin until 32 weeks of gestation when she was converted to another low molecular weight heparin, dalteparin, given by twice daily injection (100u/kg). Anti-Xa levels were in the therapeutic range at 0.9 u/ mL (0.4-1.0 u/mL). She was delivered of a healthy infant by uncomplicated elective caesarean section at 34 weeks and was warfarinised postnatally. Case report 2A 28 year old woman in her fourth pregnancy had undergone a mechanical prosthetic (Starr-Edwards) mitral valve replacement, also for valvular damage secondary to rheumatic fever as a child. Her past obstetric history included two early terminations of pregnancy and one emergency caesarean section for severe pre-eclampsia at 32 weeks of gestation in 1993. She was anticoagulated with warfarin during the latter pregnancy. Since her mitral valve replacement she had been poorly compliant on warfarin and had suffered a left temporoparietal infarct.She conceived while taking warfarin and was converted to tinzaparin (175 units/kg) at eight weeks of gestation, which was administered, as a once daily dose, under supervision on a daily outpatient basis. At 11 weeks of gestation she was found collapsed at home and on admission had a dense right-sided hemiparesis and aphasia. A CT scan showed an old left tempoparietal infarct with no new areas of haemorrhage and a clinical diagnosis of a thrombotic cerebrovascular accident was made. Her anti-Xa levels measured on admission were therapeutic. She was treated with intravenous unfractionated heparin, maintaining the activated partial thromboplastin time of 2.0 and 2.5 times the control, and then restarted on therapeutic doses of tinzaparin until 16 weeks of gestation when she was re-warfarinised.At 30 weeks of gestation she developed acute pulmonary ooedema secondary to fast atrial ®brillation and underwent an emergency caesarean section due to deterioration in her clinical state. Prior to this deterioration the International Normalised Ratio (INR) was maintained in the therapeutic range. There was no suggestion that the deterioration in the clinical state was due to thrombotic complications. Case report 3A 23 year old woman developed haemoptysis and shortness of breath during her ®rst pregnancy in 1995. She ...

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Section: Discussionmentioning

confidence: 99%

Thromboembolism in pregnant women with mechanical prosthetic heart valves anticoagulated with low molecular weight heparin

Roberts

Ross

Flint

et al. 2001

BJOG

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“…The critical period for malformations is between 6 and 12 weeks of gestation (Hall et al 1980;Chan et al 2000;Iturbe-Alessio et al 1986). Exposure in the second and third trimesters may be associated with an increased risk of CNS damage and stillbirth due to fetal hemorrhage (Hall et al 1980;Iturbe-Alessio et al 1986;Ville et al 1993;van Driel et al 2002). There is also a reported increase in spontaneous abortions in women taking warfarin although this could be related to the underlying disease (Born et al 1992).…”

Section: Warfarin (Coumadin)mentioning

confidence: 95%

Medication Use in Pregnancy; Treating the Mother: Protecting the Unborn

Gadot

Koren

2014

Medicines for Women

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“…Deaths from fetal intraventricular haemorrhage have occurred with warfarin ingestion even when the International Normalized Ratio is within the therapeutic range 12 . The mid‐gestation fetal liver has undetectable levels of vitamin K2, with vitamin K1 only 20% that of adult values.…”

Section: Oral Anticoagulants: Fetal and Maternal Complicationsmentioning

confidence: 99%