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April 29, 2009American Journal of Perinatology

Warfarin-Associated Fetal Intracranial Hemorrhage in Woman with Mitral Valve Replacements: A Case Report

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Population

39-year-old pregnant woman with a history of mitral valve replacement 23 years prior (n=1)

Design

Case_report

Follow-up

Up to 23 weeks of gestation

Authors

HMHitoshi MasamotoOkinawa Red Cross HospitalHUHiroyuki UeharaNagano Prefectural Suzaka HospitalKMKeiko MekaruUniversity of the Ryukyus University Hospital

Discussion

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Implication

Maternal PT/INR may not ensure fetal safety with warfarin; this case leaves open optimal monitoring and alternative strategies.

Key Points

  • To document a case of fetal intracranial hemorrhage associated with maternal warfarin therapy in a patient with a mechanical mitral valve replacement.
  • Clinical case evaluation of a 39-year-old pregnant woman on long-term warfarin (23 years) following mitral valve replacement.
  • The therapeutic regimen involved transitioning from warfarin to heparin between 6 and 21 weeks of gestation, followed by resumption of oral warfarin (3.5 mg daily) under strict PT/INR monitoring.
  • Fetal intracranial hemorrhage occurred at 23 weeks of gestation shortly after resuming maternal warfarin therapy.
  • Maternal PT/INR levels did not correlate with fetal warfarin exposure or coagulopathy, demonstrating that normal maternal parameters do not prevent fetal bleeding.

Structured PICO

P
Population
39-year-old pregnant woman with a history of mitral valve replacement 23 years prior (n=1)
I
Intervention
Oral warfarin 3.5 mg per day with strict PT/INR control, started at 21 weeks of gestation (after heparin from 6 to 21 weeks)
O
Outcome
Fetal intracranial hemorrhagesafety

This case highlights that maternal PT/INR does not correlate well with fetal warfarin activity, and fetal intracranial hemorrhage can occur despite strict maternal coagulation control.

Cite This Study

Masamoto et al. (2009) studied this question.

synapsesocial.com/papers/6a825f56004fcf503374ae71https://doi.org/10.1055/s-0029-1220781
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Also Consider

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

  1. 1Warfarin-associated Fetal Intracranial Hemorrhage: A Case Report2003 · 27 citations
  2. 2Treasure to the mother and threat to the fetus: case report of warfarin-associated fetal intracranial hemorrhage and review of literature2023 · 10 citations
  3. 3Warfarin-associated intracranial haemorrhage in pregnant woman with double mechanical valve replacement: a case presentation2020 · 4 citations
  4. 4A Case of a Pregnant Woman with Thrombosis in an Artificial Aortic Valve Resulting in Severe Cerebral Hemorrhage in the Newborn2018 · 2 citations
  5. 5Warfarin Treatment during Pregnancy: a Clinical Note2009 · 8 citations