Document Detail


Anticoagulant management of pregnancy following heart valve replacement in the United Kingdom, 1986-2002.
MedLine Citation:
PMID:  18980086     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Patients with mechanical heart valves require anticoagulation which is associated with significant maternal mortality (1-4%) and fetal complications (31%) in pregnancy. The study aim was to identify anticoagulant protocols and outcomes for pregnant women undergoing heart valve replacement (HVR) in the United Kingdom. METHODS: Women aged between 18 and 45 years and registered with the United Kingdom Heart Valve Registry (UKHVR) each completed a questionnaire, and their obstetric notes were reviewed. The data analyzed included valve type (mechanical, bioprosthetic, homograft), valve site (mitral, aortic, tricuspid, pulmonary), anticoagulation at confirmation of pregnancy, between 6-12 weeks and from 12 weeks to term, delivery, maternal and fetal outcomes, and cause of death. The summary statistics and a descriptive review of the findings are reported. RESULTS: Of 2,532 women eligible for the study, 922 responded. Among these women, 72 became pregnant, with 60 pregnancies in the mechanical valve (MV) group and 45 in the tissue valve (TV) group. Three anticoagulation regimes were used during early pregnancy: unfractionated heparin (UFH), low-molecular-weight heparin (LMWH) or warfarin. All women received warfarin in the second trimester and heparin for delivery. Live births were recorded in 30% of MV pregnancies and in 60% of TV pregnancies. Miscarriage rates differed markedly (37% MV versus 2% TV). Fetal outcome was poorest in the warfarin-only group, with embryopathy occurring at a dose level of 6 mg. The maternal outcomes did not differ significantly among groups. High-dose heparin during the first trimester and for delivery was effective for the majority of mechanical valves. CONCLUSION: The study results illustrate the diverse and uncertain manner in which UKHVR patients are managed during pregnancy. A national notification system would record much-needed prospective information on anticoagulation and pregnancy outcomes, thus aiding evidence-based management.
Authors:
Muriel S Shannon; Maria-Benedicta Edwards; Fiona Long; Kenneth M Taylor; Jans Peder Bagger; Michael De Swiet
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  17     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-11-04     Completed Date:  2009-01-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  526-32     Citation Subset:  IM    
Affiliation:
Department of Haematology, St. George's Hospital, London. mshannon@sgul.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / mortality
Adolescent
Adult
Anticoagulants / adverse effects,  therapeutic use*
Bioprosthesis*
Cause of Death
Dose-Response Relationship, Drug
Female
Fetal Diseases / chemically induced,  mortality
Great Britain
Heart Failure / mortality
Heart Valve Prosthesis Implantation*
Heparin / adverse effects,  therapeutic use
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use
Humans
Middle Aged
Postoperative Complications / drug therapy*,  mortality
Pregnancy
Pregnancy Complications, Cardiovascular / drug therapy*,  mortality
Pregnancy Outcome
Risk Factors
Warfarin / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 81-81-2/Warfarin; 9005-49-6/Heparin

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


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