Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses
E Salazar,
R Izaguirre,
J Verdejo,
and
O Mutchinick
Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico.
OBJECTIVES: This report describes our experience with the use of an anticoagulant regimen of adjusted doses of subcutaneous heparin during pregnancy in women with cardiac valve prostheses. BACKGROUND: Gravid patients with prosthetic heart valves require long-term anticoagulant therapy. To avoid the increased incidence of fetal morbidity and mortality associated with the use of coumarin agents in such patients during pregnancy, anticoagulation with subcutaneous heparin has been suggested. Controversy exists concerning the appropriate treatment of these patients. METHODS: Forty pregnancies in 37 women with prosthetic heart valves were prospectively followed up. Subcutaneous heparin was administered from the 6th until the end of the 12th week and in the last 2 weeks of gestation. Heparin was given every 8 h in the first 36 cases and every 6 h in the last 4 cases, and the dose adjusted to maintain the activated partial thromboplastin time at 1.5 to 2.5 times the control level. Acenocoumarol was used at other times. RESULTS: The incidence rate of spontaneous abortions was 37.5%; there was one neonatal death (2.5%) due to cerebral hemorrhage. No signs of coumarin-induced embryopathy were found in any of the 16 live-born infants studied by the geneticist. One mother died of gastrointestinal bleeding while receiving oral anticoagulant agents. There were two cases of fatal massive thrombosis of a mitral tilting-disk prosthesis during heparin therapy. The study was interrupted after the last of these two cases. CONCLUSIONS: The regimen of adjusted doses of subcutaneous heparin used in this study is not effective to prevent thrombosis of mechanical valve prostheses during pregnancy. The use of heparin from the 6th to the 12th week of gestation does not decrease the high incidence of fetal wastage associated with anticoagulant therapy. Coumarin agents provide adequate protection against thromboembolism during pregnancy in patients with mechanical valve prostheses.
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|
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|
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|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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123(3):
437 - 442.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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Eur J Cardiothorac Surg,
March 1, 2002;
21(3):
577 - 579.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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January 1, 2001;
107(1):
123 - 129.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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January 1, 2001;
119(2009):
22S - 38S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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April 1, 2000;
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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Arch Intern Med,
January 24, 2000;
160(2):
191 - 196.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S S Meschengieser, C G Fondevila, M T Santarelli, and M A Lazzari
Anticoagulation in pregnant women with mechanical heart valve prostheses
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July 1, 1999;
82(1):
23 - 26.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. North, L. Sadler, A. W. Stewart, L. M.E. McCowan, A. R. Kerr, and H. D. White
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Circulation,
May 25, 1999;
99(20):
2669 - 2676.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Vitale, M. De Feo, L. S. De Santo, A. Pollice, N. Tedesco, and M. Cotrufo
Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves
J. Am. Coll. Cardiol.,
May 1, 1999;
33(6):
1637 - 1641.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. L. Messmore Jr, R. Kundur, W. Wehrmacher, and P. Scanlon
Anticoagulant Therapy of Pregnant Patients with Prosthetic Heart Valves : Rationale for a Clinical Trial of Low Molecular Weight Heparin
Clinical and Applied Thrombosis/Hemostasis,
April 1, 1999;
5(2):
73 - 77.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Anticoagulation During Pregnancy
Journal Watch Cardiology,
August 1, 1996;
1996(801):
3 - 3.
[Full Text]
|
|
|
|
|
|
|
POOR OUTCOMES WITH SQ HEPARIN FOR PREGNANT WOMEN
Journal Watch (General),
June 18, 1996;
1996(618):
5 - 5.
[Full Text]
|
|
|
|
