Combination anticoagulation strategy in pregnancy with mechanical valves: The KYBELE study

华法林 医学 低分子肝素 怀孕 血栓 血栓形成 产科 外科 内科学 心房颤动 生物 遗传学
作者
Mehmet Özkan,Ahmet Güner,Sabahattin Gündüz,Gazi Yıldız,Ayşe Yıldırım,Macit Kalçık,Mahmut Yesın,Emrah Bayam,Semih Kalkan,Mustafa Ozan Gürsoy,Alev Kılıçgedik,Zübeyde Bayram,Münevver Sarı,Mehmet Aytürk,Süleyman Karakoyun,Mehmet Ali Astarcıoğlu,Elif Cansu Gündoğdu,Asuman Biçer,Emre Gürcü,Tuncer Koçak,Recep Demirbağ
出处
期刊:American Heart Journal [Elsevier]
卷期号:273: 21-34 被引量:1
标识
DOI:10.1016/j.ahj.2024.03.015
摘要

Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin.This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs. All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH+2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT).Any fetal loss was determined as primary fetal outcome. The study included 78 pregnancies in 65 women with MHVs.Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively.The rates of primary maternal outcome (44 vs 3.5%, p<0.001), obstructive MVT (16 vs 0%, p=0.04), MVT requiring treatment (28 vs 0%, p=0.003), and cerebral embolism (24 vs 3.4%, p=0.041) were found to be significantly higher in lone LMWH group compared to LMWH+4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, p=0.015) and treatment for MHV thrombus (4.2 vs 28%, p=0.049) were significantly lower in LMWH+2.5 mg warfarin group compared to lone LMWH group.The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH+2.5 mg warfarin group, and 11 (37.9%) in LMWH+4 mg warfarin group (p=0.890 for 3-group).Warfarin related-embryopathy was not observed in any case. The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs. Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women [median age 32 (27-35) years] were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.
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