How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !

The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC equivalent zone. There are several important systemic, placental, (Fetal) and cardiac indications for anticoagulants and antiplatelet agents in pregnancy. The list is increasing in a steady fashion. (Most IVF pregnancies seem to need it for some unknown reason) Risk of VTE Recurrent pregnancy loss(Placental micro-circulation clogging) SLE/APLA syndrome /Scleroderma VTE related PAH Mitral valve disease with AF. Cardiomyopathy Finally most importantly prosthetic heart valves & other Intra cardiac devices. We have few options Warfarin (Molecular weight 300 Daltons) is used in dose of 2- 10mg Un-fractioned regular Heparin , (40000 Daltons) -Not practical for long term. Used at peripartum phase , just before labor to take control over possible PPH. LMWH (Molecular weight 5000 Daltons) NOACs are not an option as of now As...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs