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March 4, 2014Interactive Cardiovascular and Thoracic Surgery

Limited dose warfarin throughout pregnancy in patients with mechanical heart valve prosthesis: a meta-analysis

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Why the study?

Does limited dose warfarin (≤ 5 mg/day) throughout pregnancy improve fetal and maternal safety outcomes in patients with mechanical heart valve prostheses?

Population

494 pregnancies in patients with a mechanical heart valve prosthesis across 11 studies.

Comparison

Limited dose warfarin throughout pregnancy, with… vs Higher INR target in a subgroup analysis.

Design

Meta-analysis

Follow-up

throughout pregnancy

Authors

AHAhmed HassounaAin Shams UniversityHAHemat AllamNational Research Centre

Discussion

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Implication

Supports lower INR targets with limited-dose warfarin in pregnant mechanical valve patients; extends meta-analytic safety data for optimized regimens.

Structured PICO

Does limited dose warfarin (≤ 5 mg/day) throughout pregnancy improve fetal and maternal safety outcomes in patients with mechanical heart valve prostheses?

P
Population
494 pregnancies in patients with a mechanical heart valve prosthesis across 11 studies.
I
Intervention
Limited dose warfarin (≤ 5 mg/day) throughout pregnancy, with a subgroup targeting a lower INR (1.5-2.5).
C
Comparator
Higher INR target (2.5-3.5) in a subgroup analysis.
O
Outcome
Adverse foetal and maternal outcomes (embryopathy, foetal loss, spontaneous abortion, maternal death, prosthetic valve thrombosis, total thromboembolic events, major maternal bleeding).safety

Limited dose warfarin (≤ 5 mg/day) throughout pregnancy in women with mechanical heart valves is associated with low rates of embryopathy and maternal complications, with even better fetal outcomes when targeting a lower-than-recommended INR of 1.5-2.5.

Limitations

  • Foetal embryopathy and prosthetic valve thrombosis were not robust on sensitivity analysis
  • Lack of large randomized controlled trials

Cite This Study

Hassouna et al. (2014) studied this question.

synapsesocial.com/papers/69d56e0975589c71d767d30bhttps://doi.org/10.1093/icvts/ivu009

Topics

Anticoagulation in AF
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The effect of warfarin dosage on maternal and fetal outcomes in pregnant women with prosthetic heart valves2011 · 44 citations
  2. 2Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves1999 · 495 citations
  3. 3Anticoagulation for Prosthetic Heart Valves in Pregnancy. Is There an Answer?2007 · 39 citations
  4. 4Anticoagulation in Patients with Mechanical Valves during Pregnancy2005 · 55 citations
  5. 5Is there a suitable method of anticoagulation in pregnant patients with mechanical prosthetic heart valves?2012 · 25 citations