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Thromboembolism in pregnancy: challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves.

Abstract
Thromboembolism in pregnancy is an important clinical issue. Despite identification of maternal and pregnancy-specific risk factors for development of pregnancy-associated venous thromboembolism, limited data are available to inform on optimal approaches for prevention. The relatively low overall prevalence of pregnancy-associated venous thromboembolism has prompted debate about the validity of recommendations, which are mainly based on expert opinion, and have resulted in an increased use of pharmacological thromboprophylaxis in pregnancy and postpartum. A pragmatic approach is required in the absence of more robust data. Anticoagulation management of pregnant women with mechanical prosthetic heart valves is particularly challenging. Continuation of therapeutic anticoagulation during pregnancy is essential to prevent valve thrombosis. Warfarin, the most effective anticoagulant, is associated with adverse fetal outcomes, including embryopathy and stillbirth. Fetal outcome is improved with therapeutic-dose low-molecular-weight heparin, but there may be more thromboembolic complications. More intensive anticoagulation, targeting higher trough anti-Xa levels, may reduce the risk of valve thrombosis.
AuthorsClaire McLintock
JournalBest practice & research. Clinical obstetrics & gynaecology (Best Pract Res Clin Obstet Gynaecol) Vol. 28 Issue 4 Pg. 519-36 (May 2014) ISSN: 1532-1932 [Electronic] Netherlands
PMID24814194 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2014 Elsevier Ltd. All rights reserved.
Chemical References
  • Anticoagulants
  • Warfarin
  • Heparin
Topics
  • Anticoagulants (administration & dosage, adverse effects)
  • Delivery, Obstetric
  • Drug Monitoring
  • Female
  • Fetal Diseases (chemically induced)
  • Heart Valve Prosthesis (adverse effects)
  • Heparin (administration & dosage, adverse effects)
  • Humans
  • Pregnancy
  • Pregnancy Complications, Cardiovascular (epidemiology, etiology, prevention & control)
  • Risk Factors
  • Thromboembolism (epidemiology, etiology, prevention & control)
  • Warfarin (administration & dosage, adverse effects)

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