Document Detail

Acenocoumarol and pregnancy outcome in a patient with mitral valve prosthesis: a case report.
MedLine Citation:
PMID:  19270459     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is considerable controversy concerning the correct management of gravid patients with cardiac valve prostheses. CASE REPORT: We describe the uneventful course of pregnancy and delivery in a pregnant patient with a mechanical heart valve receiving anticoagulation treatment. A 35-year-old primigravida received anticoagulation throughout pregnancy because of mitral valve replacement at the age of 16 due to rheumatic disease. The antithrombotic regimen used was acenocoumarol (coumarin derivative) 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). A healthy male infant was born 2,560 g, Apgar scores 8 and 10 at 1 and 5 min. No coumarin embryopathy was revealed and the postoperative course of the mother was uneventful. CONCLUSION: Even though the use of acenocoumarol throughout pregnancy replaced by LMWH in the 1st trimester was proven safe and efficacious in this case report, large randomized controlled studies are still needed to make definitive recommendations about optimal antithrombotic therapy in pregnant patients with mechanical heart valves.
Konstantinos Stefanidis; Dimitris Papoutsis; George Daskalakis; Dimitris Loutradis; Aris Antsaklis
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-03-06
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  25     ISSN:  1421-9964     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:  2009  
Date Detail:
Created Date:  2009-08-26     Completed Date:  2009-11-17     Revised Date:  2010-01-10    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  115-8     Citation Subset:  IM    
Copyright Information:
(c) 2009 S. Karger AG, Basel.
Alexandra Maternity Hospital, 1st Department of Obstetrics and Gynecology, University of Athens, Medical School, Athens, Greece.
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MeSH Terms
Acenocoumarol / adverse effects*,  therapeutic use
Anticoagulants / adverse effects*,  therapeutic use
Enoxaparin / adverse effects*,  therapeutic use
Heart Valve Prosthesis*
Mitral Valve*
Pregnancy Complications, Cardiovascular / drug therapy*
Pregnancy Outcome
Pregnancy Trimesters
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; 152-72-7/Acenocoumarol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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