Postpartum anticoagulation in women with mechanical heart valves
| Autor: | Katherine H. Campbell, Ann Santa-Ines, Heather S. Lipkind, Roxanna A. Irani, Michael J. Paidas, Robert W. Elder |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Blood transfusion medicine.medical_treatment Oncology and Carcinogenesis International Journal of Women's Health Reproductive health and childbirth 030204 cardiovascular system & hematology Cardiovascular Low Birth Weight and Health of the Newborn 7.3 Management and decision making Mechanical heart Paediatrics and Reproductive Medicine 03 medical and health sciences 0302 clinical medicine Clinical Research Preterm Intensive care Infant Mortality Maternity and Midwifery medicine Conditions Affecting the Embryonic and Fetal Periods mechanical heart valve anticoagulation Stroke Original Research Pediatric Pregnancy 030219 obstetrics & reproductive medicine Obstetrics business.industry Prevention Obstetrics and Gynecology Gestational age Retrospective cohort study Hematology Perinatal Period - Conditions Originating in Perinatal Period medicine.disease Good Health and Well Being Oncology postpartum hemorrhage Gestation Management of diseases and conditions pregnancy business |
| Zdroj: | International Journal of Women's Health |
| ISSN: | 1179-1411 |
| Popis: | Roxanna A Irani,1,* Ann Santa-Ines,2,* Robert W Elder,2 Heather S Lipkind,1 Michael J Paidas,1 Katherine H Campbell1 1Department of Obstetrics, Gynecology and Reproductive Sciences, Section of Maternal-Fetal Medicine, Yale University School of Medicine, New Haven, CT, USA; 2Department of Pediatrics, Section of Pediatric Cardiology, Adult Congenital Heart Program, Yale University School of Medicine, New Haven, CT, USA *These authors contributed equally tothis work Background: Women with mechanical heart valves (MHV) requiring anticoagulation (AC) are at high risk for hemorrhagic complications. Despite guidelines to manage antenatal and peripartum AC, there are few evidence-based recommendations to guide the initiation of postpartum AC. We reviewed our institutional experience of pregnant women with MHV to lay the groundwork for recommendations of immediate postpartum AC therapy.Study design: This descriptive retrospective cohort used ICD-9 and -10 codes to identify pregnant women with MHV on AC at the Yale-New Haven Hospital from 2007 to 2018. All identified patients were confirmed by chart review. Delivery hospitalization and the immediate postpartum AC management were reviewed. Maternal complications recorded were postpartum hemorrhage, transfusion, wound hematoma, intra-abdominal bleeding, stroke, valve thrombosis, and death. Further, immediate neonatal outcomes were detailed.Results: Forty-two pregnant women with nonnative heart valves were identified during the study period. From those pregnant women, nine had an MHV and were anticoagulated throughout gestation. Of 19 total pregnancies, 14 met the inclusion criteria. The median gestational age of the delivered pregnancies was early term (37w2d). Nine deliveries were via cesarean (64%). The median time to restart AC after birth was 6 hours. After six deliveries (43%), AC was initiated ≤6 hours postpartum. Hemorrhagic complications occurred in six cases (43%), including wound and intra-abdominal hematomas. Four cases (29%) required blood transfusion. No maternal strokes, thrombotic events, or deaths were recorded. Five (38.5%) neonates required admission to the neonatal intensive care unit.Conclusion: MHV in pregnancy was rare but was associated with significant maternal morbidity, particularly postpartum hemorrhagic complications. We noted significant variability in the timing of restarting postpartum AC and in the selected agents. Pooled institutional data and an interdisciplinary approach are recommended to minimize competing risks and sequelae of valve thrombosis and obstetrical hemorrhage and, thereby, to optimize maternal outcomes and develop evidence-based guidelines for postpartum AC management. Keywords: pregnancy, anticoagulation, postpartum hemorrhage, mechanical heart valve |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|