Cardiology MCQ – Anticoagulation in pregnancy – Answer

Cardiology MCQ – Anticoagulation in pregnancy – Answer My Cardiology MCQ books on Amazon Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with: Correct answer: 3. Warfarin Best maternal outcome in pregnancy with mechanical prosthetic valves is obtained with warfarin [1]. But it is a known teratogen and is associated with lowest number of live births. Low molecular weight heparin probably gives the best fetal outcome, though the maternal risk of thromboembolism is higher. Dabigatran is not recommended for mechanical prosthetic valves even without pregnancy. Generally warfarin is avoided in first trimester and near term and heparin or low molecular weight heparin used instead. Some studies have shown that warfarin doses less than 5 mg have less fetal toxicity. Best fetal outcome may be with low molecular weight heparin used throughout pregnancy. But there is a higher risk of maternal thromboembolic events compared to warfarin. Back to question Reference D’Souza R, Ostro J, Shah PS, Silversides CK, Malinowski A, Murphy KE, Sermer M, Shehata N. Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis. Eur Heart J. 2017; 38:1509–1516.
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

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Pregnancy outcomes in women with mechanical heart valves (MHV) remain poor. The thrombogenicity of MHV, the hypercoagulable state of pregnancy and limitations of current anticoagulation strategies combine to give a very high risk state. Recent additions to the literature in the form of registry data as well as meta-analyses and systematic reviews have highlighted the risks of thrombotic and haemorrhagic events in mothers and increased fetal complication rates. There remains a lack of consensus about the optimal anticoagulation approach to mitigate the risks to mother and fetus and registry data confirm poor quality of care.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Review Article Source Type: research
CONCLUSION:: Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and foetal outcomes in a patient with a prosthetic heart valve. PMID: 30624139 [PubMed - as supplied by publisher]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
S, Özkan M Abstract Pregnancy is associated with an increased risk of valve thrombosis in patients with a mechanical prosthetic heart valve. The administration of low molecular weight heparin (LMWH) with regular anti-factor Xa assessment is a recommended treatment modality for these patients. Presently described are 3 cases of therapy with LMWH during pregnancy. Despite frequent anti-factor Xa monitoring, not surprisingly, all of them developed prosthetic valve thrombosis. PMID: 30628904 [PubMed - in process]
Source: Turk Kardiyoloji Dernegi arsivi - Category: Cardiology Authors: Tags: Turk Kardiyol Dern Ars Source Type: research
Authors: Akbayrak H, Çiçek ÖF, Orhan A Abstract A mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. She had 2 previous cardiac operations in her medical history. A stuck mechanical valve was diagnosed in the mitral position&nb...
Source: Saudi Medical Journal - Category: Middle East Health Tags: Saudi Med J Source Type: research
AbstractPurpose of the reviewTo review the management of women with mechanical heart valves during pregnancy, from preconception counseling through delivery with a summary of the latest guidelines.Recent findingsThe hypercoagulability of pregnancy combined with the imperfect choices of anticoagulant agents contribute to a high risk of complications in pregnant women with mechanical heart valves. Valve thrombosis remains a major concern, much of which occurs during the first trimester transition to heparin-based products. The safest method of anticoagulation, with the best balance of maternal and fetal risk, is use of low-d...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
CONCLUSION: Although a lower prevalence of warfarin-induced teratogenicity is reported with low-dose warfarin, a safe "cut-off" dose is misleading. Teratogenic risk with warfarin is unpredictable, mandating individual decisions regardless of the dose. PMID: 30390948 [PubMed - in process]
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
Publication date: Available online 17 September 2018Source: Journal of Cardiology CasesAuthor(s): Toshinori Komatsu, Hirohiko Motoki, Kazuhiro Kimura, Tatsuya Saigusa, Soichiro Ebisawa, Yusuke Yokokawa, Hirofumi Ando, Takashi Ichino, Koichiro KuwaharaAbstractA 29-year-old woman was admitted to our hospital due to diagnosis of pregnancy at 5 weeks and a day. She underwent valve replacement with mechanical heart valve (MHV: SJM valve) for congenital mitral valve regurgitation, when 11 years old. Warfarin 4 mg was used for anticoagulation. After admission, warfarin was replaced by unfractionated heparin (UFH). She develo...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Abstract Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia. It is characterized by the presence of antiphospholipid antibodies (APL) that are directed against phospholipid-binding plasma proteins, such as beta-2-glycoprotein I (b2GPI). Its main manifestations are recurrent vascular thromboses (so-called "thrombotic APS") and pregnancy complications ("obstetric APS"). According to the current consensus criteria, a persistently positive functional lupus anticoagulant (LA) assay and/or the presence of anti-b2GPI and/or anti-cardiolipin antibodies, together with cli...
Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases - Category: Surgery Authors: Tags: Vasa Source Type: research
CONCLUSION: Complication rates were high despite centralised care. PMID: 30059130 [PubMed - as supplied by publisher]
Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Tags: Cardiovasc J Afr Source Type: research
Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary. In thi...
Source: Clinical Obstetrics and Gynecology - Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research
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