Document Detail

Anticoagulation for prosthetic heart valves in pregnancy. Is there an answer?
MedLine Citation:
PMID:  18042774     Owner:  NLM     Status:  MEDLINE    
The aim of this retrospective study was to compare the different anticoagulation regimens used in pregnant women with prosthetic heart valves. We reviewed 196 pregnancies in 110 women from 1974 to 2000. The patients were divided into two groups: group 1 (142 pregnancies) had warfarin throughout pregnancy; and in group 2 (54 pregnancies), warfarin was replaced by subcutaneous heparin during the first trimester and last two weeks of pregnancy. There were no maternal complications in 129 pregnancies in group 1 and 44 in group 2. There were significantly fewer normal births in group 1 (56; 39.4%) compared to group 2 (39; 72.2%). Group 1 had a significantly higher rate of spontaneous abortion (46.5% vs 14.8%), but group 2 had a higher rate of valve thrombosis. In group 1, women with a warfarin requirement < 5 mg had a lower rate of spontaneous abortion. Warfarin is an effective anticoagulant in pregnant women with mechanical valves but it results in significant fetal loss when the dose is > 5 mg. Heparin is a less effective anticoagulant resulting in more maternal complications, but it is more protective of the fetus.
Amir J Khamooshi; Fahimeh Kashfi; Saeed Hoseini; Mohammad B Tabatabaei; Hossein Javadpour; Fereydoon Noohi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Asian cardiovascular & thoracic annals     Volume:  15     ISSN:  1816-5370     ISO Abbreviation:  Asian Cardiovasc Thorac Ann     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-28     Completed Date:  2008-05-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503417     Medline TA:  Asian Cardiovasc Thorac Ann     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  493-6     Citation Subset:  IM    
Department of Cardiac Surgery & Cardiology, Shahid Rajaee Heart Centre, Tehran, Iran.
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MeSH Terms
Abortion, Spontaneous / chemically induced
Administration, Oral
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use*
Dose-Response Relationship, Drug
Drug Administration Schedule
Fetus / drug effects
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / adverse effects*,  instrumentation
Heparin / administration & dosage,  adverse effects,  therapeutic use*
Injections, Subcutaneous
Patient Selection
Pregnancy Complications, Cardiovascular / prevention & control*
Prosthesis Design
Retrospective Studies
Risk Assessment
Thrombosis / etiology,  prevention & control*
Treatment Outcome
Warfarin / administration & dosage,  adverse effects,  therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 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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