PMID- 26927861
OWN - NLM
STAT- MEDLINE
DCOM- 20170717
LR  - 20181202
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 32
IP  - 10
DP  - 2016 Oct
TI  - Anticoagulation Regimens During Pregnancy in Patients With Mechanical Heart 
      Valves: A Systematic Review and Meta-analysis.
PG  - 1248.e1-1248.e9
LID - S0828-282X(15)01581-0 [pii]
LID - 10.1016/j.cjca.2015.11.005 [doi]
AB  - BACKGROUND: Managing anticoagulation in pregnant women with mechanical heart 
      valves remains challenging. Our aim was to evaluate the effectiveness and safety 
      of 4 regimens in these women. METHODS: Relevant studies published before June 
      2015 were collected in several databases and analyzed with RevMan version 5.3 and 
      SPSS version 19.0. Four regimens were defined as follows: a regimen of a vitamin 
      K antagonist (VKA) throughout pregnancy; a heparin (H)/VKA regimen using VKAs 
      except for unfractionated heparin (UFH) or low molecular weight heparin (LMWH) 
      during 6-12 weeks of pregnancy; a LMWH regimen of adjusted LMWH doses throughout 
      pregnancy; and a UFH regimen of adjusted UFH doses throughout pregnancy. The low 
      warfarin dose in the VKA regimen was defined as 5 mg/d or less. RESULTS: 
      Fifty-one studies comprising 2113 pregnancies in 1538 women were included. The 
      rate of fetal wastage was significantly higher in the high warfarin dose subgroup 
      than in the low dose one. Compared with the H/VKA regimen, the rate of maternal 
      major thromboembolic event in the low-dose VKA regimen group was significantly 
      lower, although the fetal outcomes were similar. Compared with the H/VKA regimen, 
      the rate of fetal wastage in the LMWH regimen group was significantly lower, and 
      the maternal outcomes were similar. The UFH regimen presented the worst maternal 
      and fetal outcomes. CONCLUSIONS: In the absence of large prospective trials, this 
      meta-analysis showed that the VKA regimen should be best for pregnant women with 
      a low warfarin dose, and the H/VKA regimen might be reasonable for those with a 
      high warfarin dose. The LMWH regimen could be used for those who refuse VKA.
CI  - Copyright (c) 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All 
      rights reserved.
FAU - Xu, Zhe
AU  - Xu Z
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Fan, Jin
AU  - Fan J
AD  - Division of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan 
      University, PR China.
FAU - Luo, Xin
AU  - Luo X
AD  - Division of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan 
      University, PR China.
FAU - Zhang, Wen-Bo
AU  - Zhang WB
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Ma, Jun
AU  - Ma J
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Lin, Yu-Bi
AU  - Lin YB
AD  - Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, 
      Guangdong General Hospital, PR China.
FAU - Ma, Shao-Hong
AU  - Ma SH
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Chen, Xin
AU  - Chen X
AD  - Division of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan 
      University, PR China.
FAU - Wang, Zhi-Ping
AU  - Wang ZP
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Ou, Jing-Song
AU  - Ou JS
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China.
FAU - Zhang, Xi
AU  - Zhang X
AD  - Division of Cardiac Surgery, The First Affiliated Hospital of Sun-Yat-sen 
      University, Guangdong, PR China. Electronic address: himybox@126.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20151112
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
RN  - 0 (Anticoagulants)
RN  - 12001-79-5 (Vitamin K)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Abnormalities, Drug-Induced
MH  - Abortion, Induced
MH  - Abortion, Spontaneous
MH  - Anticoagulants/therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Maternal Mortality
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/*prevention & control
MH  - Stillbirth
MH  - Thromboembolism/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2016/03/02 06:00
MHDA- 2017/07/18 06:00
CRDT- 2016/03/02 06:00
PHST- 2015/04/30 00:00 [received]
PHST- 2015/10/30 00:00 [revised]
PHST- 2015/11/04 00:00 [accepted]
PHST- 2016/03/02 06:00 [pubmed]
PHST- 2017/07/18 06:00 [medline]
PHST- 2016/03/02 06:00 [entrez]
AID - S0828-282X(15)01581-0 [pii]
AID - 10.1016/j.cjca.2015.11.005 [doi]
PST - ppublish
SO  - Can J Cardiol. 2016 Oct;32(10):1248.e1-1248.e9. doi: 10.1016/j.cjca.2015.11.005. 
      Epub 2015 Nov 12.