PMID- 23452748
OWN - NLM
STAT- MEDLINE
DCOM- 20130930
LR  - 20131121
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 131 Suppl 1
DP  - 2013 Jan
TI  - Anticoagulant choices in pregnant women with mechanical heart valves: balancing 
      maternal and fetal risks--the difference the dose makes.
PG  - S8-10
LID - S0049-3848(13)70010-0 [pii]
LID - 10.1016/S0049-3848(13)70010-0 [doi]
AB  - Long-term anticoagulation is required in all patients with mechanical prosthetic 
      heart valves to prevent complications with valve thrombosis and valve failure or 
      systemic thromboembolism. The prothrombotic environment of pregnancy further 
      increases the risks of these complications. Anticoagulant choices for pregnant 
      women include oral vitamin K antagonists such as warfarin, or heparin - either 
      unfractionated heparin (UFH) or low molecular weight heparin (LMWH). None of the 
      options is without risk for the mother or her baby. Warfarin crosses the placenta 
      and is associated with warfarin embryopathy and fetopathy but is very effective 
      at preventing thromboembolic complications. The dose of warfarin may play a role 
      in the risk of some, but not all fetal complications. Heparin does not cross the 
      placenta but is less effective at preventing thrombosis and LMWH may be more 
      effective than UFH. The optimal dose and target anti-Xa levels for LMWH have not 
      been established. Measurement of trough anti-Xa levels in addition to peak 
      anti-Xa levels may be important.
CI  - Copyright (c) 2013 Elsevier Ltd. All rights reserved.
FAU - McLintock, Claire
AU  - McLintock C
AD  - National Women's Health, Auckland City Hospital, Auckland, New Zealand. 
      claire.mclintock@adhb.govt.nz
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 12001-79-5 (Vitamin K)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Cohort Studies
MH  - Factor Xa/therapeutic use
MH  - Female
MH  - Heart Valve Diseases/*complications/therapy
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Maternal Exposure
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/drug therapy
MH  - Pregnancy Complications, Hematologic/drug therapy
MH  - Pregnancy Outcome
MH  - Risk
MH  - Thromboembolism/drug therapy/prevention & control
MH  - Thrombosis/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
MH  - Warfarin/therapeutic use
EDAT- 2013/03/15 06:00
MHDA- 2013/10/01 06:00
CRDT- 2013/03/05 06:00
PHST- 2013/03/05 06:00 [entrez]
PHST- 2013/03/15 06:00 [pubmed]
PHST- 2013/10/01 06:00 [medline]
AID - S0049-3848(13)70010-0 [pii]
AID - 10.1016/S0049-3848(13)70010-0 [doi]
PST - ppublish
SO  - Thromb Res. 2013 Jan;131 Suppl 1:S8-10. doi: 10.1016/S0049-3848(13)70010-0.