Document Detail

Risks of anticoagulant therapy in pregnant women with artificial heart valves.
MedLine Citation:
PMID:  3773964     Owner:  NLM     Status:  MEDLINE    
In an attempt to identify the best treatment for pregnant women with cardiac-valve prostheses who are receiving oral anticoagulants, we studied 72 pregnancies prospectively. In 23 pregnancies (Group I), the coumarin derivative acenocoumarol was discontinued and the patients received 5,000 U of subcutaneous heparin every 12 hours from the 6th to the 12th week of gestation, in 12 pregnancies (Group II), heparin was not substituted for the coumarin derivative until after the 7th week, and in 37 pregnancies, detected after the first trimester (Group III), the coumarin derivative was given throughout gestation. In most patients heparin was again substituted for the oral anticoagulant after the 38th week. Three mothers had thrombosis of a tilting-disk mitral prosthesis (two cases were fatal) during heparin treatment. No differences were found in the rates of spontaneous abortion in the three groups. Coumarin embryopathy occurred in 25 percent and 29.6 percent of the pregnancies in Groups II and III, respectively. We conclude that in the second and third trimesters of pregnancy, coumarin derivatives provide effective protection against thromboembolism while causing few fetopathic effects, but that these agents are contraindicated from the 6th to the 12th weeks of gestation. Low-dose heparin does not protect against prosthetic-valve thrombosis, and the possibility that a larger dose might be more effective requires further exploration.
I Iturbe-Alessio; M C Fonseca; O Mutchinik; M A Santos; A Zajarías; E Salazar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  315     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1986 Nov 
Date Detail:
Created Date:  1986-12-15     Completed Date:  1986-12-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1390-3     Citation Subset:  AIM; IM    
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MeSH Terms
Abnormalities, Drug-Induced / etiology
Abortion, Spontaneous / chemically induced
Acenocoumarol / administration & dosage,  adverse effects
Coumarins / administration & dosage,  adverse effects*
Drug Administration Schedule
Fetal Death / chemically induced
Fetus / drug effects*
Heart Valve Prosthesis*
Heparin / administration & dosage,  adverse effects
Infant, Newborn
Pregnancy Complications, Cardiovascular / prevention & control*
Pregnancy Trimester, First
Thromboembolism / prevention & control*
Reg. No./Substance:
0/Coumarins; 152-72-7/Acenocoumarol; 9005-49-6/Heparin

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

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