Key result
Coumarin exposure during pregnancy after cardiac valve replacement was associated with 53.2% fetal wastage, compared to 36.4% with heparin and 16.7% without anticoagulants.
Why the study?
How do different anticoagulation strategies affect fetal and maternal outcomes in women who conceive after cardiac valve replacement?
Observational (n=40)
How do different anticoagulation strategies affect fetal and maternal outcomes in women who conceive after cardiac valve replacement?
Pregnancy after cardiac valve replacement carries high risks of fetal wastage, particularly with coumarin use, and significant maternal morbidity, highlighting the complex challenge of anticoagulation management in this population.
Supports avoiding coumarins in pregnancy after valve replacement due to high fetal wastage; leaves open optimal regimens for prospective trials.
The outcome of 64 pregnancies in 40 women who conceived after cardiac valve replacement were reviewed. Fetal wastage was 53.2% (25/47) in coumarin administered pregnancies, 36.4% (4/11) using heparin and 16.7% (1/6) without anticoagulants. Two fetal malformations were noted in coumarin administered pregnancies. There were two maternal deaths. Maternal morbidity due to antenatal bleeding, atrial fibrillation, thromboembolic episodes and cardiac failure were found to be 20.0% (8/40), 17.5% (7/40), 10.0% (4/40) and 10.0% (4/40), respectively.
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Ayhan et al. (1991) conducted an observational in Pregnancy after cardiac valve replacement (n=40). Coumarin vs. Heparin or no anticoagulants was evaluated on Fetal wastage. Coumarin exposure during pregnancy after cardiac valve replacement was associated with 53.2% fetal wastage, compared to 36.4% with heparin and 16.7% without anticoagulants.
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