Document Detail


Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy.
MedLine Citation:
PMID:  15467905     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Increased thromboembolic events occur in women with mechanical prosthetic valves during pregnancy, and selecting an effective and safe anticoagulant is still a challenge. Low molecular weight heparin (LMWH) is a promising alternative, but a recent warning and label change about its use in patients with mechanical prosthetic valves has caused confusion among physicians. The aim of the present study was to review the risks of maternal and fetal complications with mechanical heart valves treated with LMWH during pregnancy. We performed a review of the current medical literature through MEDLINE and EMBASE (1989 to 2004). Additional data sources included abstract proceedings, and reference lists of selected articles. Among 81 pregnancies in 75 women, the proportion of valve thrombosis was 8.64% (7/81; 95% CI, 2.52%-14.76%). The frequency of overall thromboembolic complication (TEC) was 12.35% (10/81; 95% CI, 5.19%-19.51%). Nine of ten patients with TEC received a fixed dose of LMWH and two of these received a fixed low dose of LMWH. Among 51 pregnancies whose anti-factor Xa levels were monitored, only one patient was reported to have a thromboembolic complication. The frequency of live births with LMWH was 87.65% (95%CI, 80.49%-94.81%). In pregnant women with mechanical heart valves, LMWH appears to be a suitable option to a vitamin K antagonist. The use of LMWH warrants monitoring and appropriate dose adjustments to maintain a 4-6 hr post-injection anti-factor Xa level at a minimum of 1.0 U/ml to decrease the incidence of TEC.
Authors:
Betul Oran; Aviva Lee-Parritz; Jack Ansell
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  92     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2005-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  747-51     Citation Subset:  IM    
Affiliation:
Department of Medicine, Boston University Medical Center, 650 Albany Street, Boston, MA 02118, USA. betul.oran@bmc.org
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MeSH Terms
Descriptor/Qualifier:
Drug Evaluation
Female
Heart Valve Prosthesis / adverse effects*,  statistics & numerical data
Heparin, Low-Molecular-Weight / therapeutic use*
Humans
Pregnancy
Pregnancy Complications, Hematologic / drug therapy,  prevention & control
Pregnancy Outcome
Thromboembolism / drug therapy,  prevention & control*
Chemical
Reg. No./Substance:
0/Heparin, Low-Molecular-Weight

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


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