PMID- 36174605
OWN - NLM
STAT- MEDLINE
DCOM- 20230614
LR  - 20230614
IS  - 1098-9064 (Electronic)
IS  - 0094-6176 (Linking)
VI  - 49
IP  - 5
DP  - 2023 Jul
TI  - Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and 
      Meta-Analysis.
PG  - 542-552
LID - 10.1055/s-0042-1756707 [doi]
AB  - Anticoagulant therapy is essential in pregnant women with mechanical heart valves 
      to prevent valve thrombosis. The risk of bleeding complications in these patients 
      has not gained much attention. This systematic review and meta-analysis 
      investigate the prevalence of bleeding peri-partum and post-partum in women with 
      mechanical heart valves and also investigate whether bleeding risk differed 
      across anticoagulant regimens or according to delivery mode. The present study 
      was conducted according to The Preferred Reporting Items for Systematic reviews 
      and Meta-Analyses (PRISMA) statement. Studies reporting bleeding prevalence in 
      pregnant women with mechanical heart valves receiving anticoagulant therapy were 
      identified through PubMed and Embase on December 08, 2021. Data on bleeding 
      complications, delivery mode, and anticoagulation therapy were extracted. A total 
      of 37 studies were included, reporting 423 bleeding complications in 2,508 
      pregnancies. A meta-analysis calculated a pooled prevalence of 0.13 (95% 
      confidence interval [CI]: 0.09-0.18) bleeding episodes per pregnancy across 
      anticoagulant regimens. The combination of unfractionated heparin (UFH) and 
      vitamin K antagonist (VKA) and single VKA therapy showed the lowest risk of 
      bleeding (8 and 12%). Unexpectedly, the highest risk of bleeding was found in 
      women receiving a combination of low-molecular-weight-heparin (LMWH) and VKA 
      (33%) or mono-therapy with LMWH (22%). However, this could be dose related. No 
      difference in bleeding was found between caesarean section versus vaginal 
      delivery (p = 0.08). In conclusion, bleeding episodes are common during pregnancy 
      in women with mechanical heart valves receiving anticoagulant therapy. A 
      combination of UFH and VKA or VKA monotherapy showed the lowest risk of bleeding.
CI  - Thieme. All rights reserved.
FAU - Jakobsen, Carina
AU  - Jakobsen C
AD  - Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, 
      Aarhus University Hospital, Aarhus C, Denmark.
FAU - Larsen, Julie Brogaard
AU  - Larsen JB
AD  - Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, 
      Aarhus University Hospital, Aarhus C, Denmark.
AD  - Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
FAU - Fuglsang, Jens
AU  - Fuglsang J
AD  - Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
AD  - Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus C, 
      Denmark.
FAU - Hvas, Anne-Mette
AU  - Hvas AM
AD  - Faculty of Health, Aarhus University, Aarhus C, Denmark.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20220929
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 9005-49-6 (Heparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - *Heparin/therapeutic use
MH  - *Heparin, Low-Molecular-Weight/therapeutic use
MH  - Cesarean Section
MH  - Anticoagulants/therapeutic use
MH  - Hemorrhage/drug therapy
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heart Valves
COIS- C.J. declare no conflict of interest. J.B.L. declare no conflict of interest 
      pertaining to the present paper but has the following general conflict of 
      interest: Received speaker's fees from Bristol-Myers Squibb and travel support 
      from Bayer. J.F. has received speaker's fees from CSL Behring. A.-M.H. has no 
      conflict regarding the present study but has the following general conflicts: has 
      received speaker's fee from CSL Behring and unrestricted research support from 
      CSL Behring.
EDAT- 2022/09/30 06:00
MHDA- 2023/06/14 06:42
CRDT- 2022/09/29 19:03
PHST- 2023/06/14 06:42 [medline]
PHST- 2022/09/30 06:00 [pubmed]
PHST- 2022/09/29 19:03 [entrez]
AID - 10.1055/s-0042-1756707 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2023 Jul;49(5):542-552. doi: 10.1055/s-0042-1756707. Epub 
      2022 Sep 29.