Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

Abstract Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, 13 in the sequential treatment group. There are 27 cases of spontaneous abortion, 3 cases of stillbirth, 56 live births and 51 artificial abortion. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with worse heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.

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Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

10.21203/rs.3.rs-340670/v1 ◽

2021 ◽

Author(s):

Ziwen Zhao ◽

Xi Yang ◽

Ying Su ◽

Jun Zhang ◽

Yanna Li ◽

...

Keyword(s):

Pregnant Women ◽

Spontaneous Abortion ◽

Heart Valves ◽

Heart Function ◽

Unplanned Pregnancy ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Tobit Regression ◽

Warfarin Group ◽

Tobit Regression Analysis

Abstract Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. This study investigated the outcomes and correlations of MPHV pregnant women under different anticoagulation methods. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. Various indicators of the offspring were analyzed, using single factor logistic regression and multi-factor Tobit regression to identify the main influencing factors of spontaneous abortion/stillbirth and malformation. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, and 13 in the sequential treatment group. Among these, there are 27 cases of spontaneous abortion, 3 cases of stillbirth and 56 live births. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. Conclusion: The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.

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Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172307 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2158

Author(s):

Mustafa Bahloul ◽

Armia Michael ◽

Mansour Y. Kandeel ◽

Ahmed M. Abbas

Keyword(s):

Pregnant Women ◽

Heart Valves ◽

Oral Anticoagulants ◽

Prosthetic Heart Valves ◽

Fetal Outcomes ◽

Warfarin Group ◽

Group I ◽

Significant Difference ◽

Sequential Regimen ◽

Group Ii

Background: The current study aims to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA throughout pregnancy.Methods: An observational was carried out at Assiut Women's Health Hospital, Egypt between February and December 2016. All pregnant women with prosthetic heart valves attending the emergency department during the study period were enrolled in the study. All included patients were classified into two groups; women who receive low molecular weight heparin (LMWH) during the first trimester then shift to warfarin till 36 weeks of gestation then continue on LMWH till delivery (Group I) and those who continue the all period of pregnancy on warfarin (Group II). The primary outcome of the study was the difference in the rate of maternal cardiac complications during labor between both groups.Results: The study included 72 patients have prosthetic valve replacement and on anticoagulants. Twenty-one were on oral anticoagulant; warfarin (Group II) and 51 pregnant women were on sequential regimen. Both groups were comparable in their basic and clinical data on admission. No difference between both groups in the mode of delivery (p=0.52), postpartum hemorrhage (0.09), sub rectal hematomas (p=0.08), the need for postpartum admission to ICU (p=0.93) and the duration of hospital stay (p=0.47). Additionally, no statistical significant difference between both groups as regard the mean birth weight (p=0.97), Apgar score (p=0.62), fetal sex (p=0.92) and congenital anomalies (p=0.08).Conclusions: The use of sequential LMWH and oral anticoagulants appears to be a safe option for those women although there is no difference in maternal and fetal outcomes with the use of continuous oral anticoagulants throughout the pregnancy.

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Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-12-06 ◽

2022 ◽

Vol 17 (6) ◽

pp. 831-836

Author(s):

A. S. Gerasimenko ◽

O. V. Shatalova ◽

V. S. Gorbatenko ◽

V. I. Petrov

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Clinical Guidelines ◽

Antithrombotic Therapy ◽

Heart Valves ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

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