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Mulatie Z, Aynalem M, Getawa S. Hematological profiles of newborns of mothers with hypertensive disorders of pregnancy delivered at the University of Gondar comprehensive specialized hospital: a comparative cross-sectional study. BMC Pediatr 2024; 24:17. [PMID: 38183053 PMCID: PMC10768143 DOI: 10.1186/s12887-023-04491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/17/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy can cause prenatal placental perfusion with insufficient blood supply to the fetus, resulting in fetal exposure to hypoxia and leading to disturbance of neonatal hematopoietic stem cells. This study aimed to compare the hematological profiles of newborns from mothers with hypertensive disorders and normotensive delivered at the University of Gondar comprehensive specialized hospital. METHODS A comparative cross-sectional study was conducted from March to May 2022 among 308 newborns from hypertensive and normotensive mothers in equal proportions. A systematic random sampling technique was used to select study participants. Three milliliters of cord blood were collected to perform a complete blood count by Beckman coulter. The results were presented using tables and graphs. Independent t-test and Mann-Whitney U test were done to compare the hematological profiles of the two groups. P-value < 0.05were considered statistically significant. RESULTS The majority of hypertensive and normotensive mothers' ages were between 20 and 34 years (83.77% and 90.91%, respectively). The hematocrit levels were significantly higher in neonates of hypertensive mothers than the neonates of normotensive mothers (49.10 ± 5.19% and 46.09 ± 7.63% respectively) (P < 0.001) while neutrophil counts were significantly lower in neonates of hypertensive mothers than the neonates of normotensive mothers (6.62 ± 3.30 and 7.55 ± 3.31 × 103 /ul respectively) (P = 0.007). Also, platelets counts were significantly lower in neonates of hypertensive mothers than neonates of normotensive mothers (221.25 ± 83.56 and 260.24 ± 83.01 × 103/ul respectively) (P < 0.001). The platelet and nucleated red blood cell count showed a statistically significant difference among newborns from mothers with superimposed preeclampsia and gestational hypertension. CONCLUSION Newborns delivered from hypertensive disorders of pregnancy had low white blood cell parameters, low platelet count and high red blood cell parameters compared to controls. As result, newborns may develop leukopenia, thrombocytopenia and polycythemia, respectively. Therefore, newborns should be monitored for early detection and follow-up of hematological abnormalities before complications occurred.
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Affiliation(s)
- Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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2
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Zebrafish Models to Study Ectopic Calcification and Calcium-Associated Pathologies. Int J Mol Sci 2023; 24:ijms24043366. [PMID: 36834795 PMCID: PMC9967340 DOI: 10.3390/ijms24043366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Ectopic calcification refers to the pathological accumulation of calcium ions in soft tissues and is often the result of a dysregulated action or disrupted function of proteins involved in extracellular matrix mineralization. While the mouse has traditionally been the go-to model organism for the study of pathologies associated with abnormal calcium deposition, many mouse mutants often have exacerbated phenotypes and die prematurely, limiting the understanding of the disease and the development of effective therapies. Since the mechanisms underlying ectopic calcification share some analogy with those of bone formation, the zebrafish (Danio rerio)-a well-established model for studying osteogenesis and mineralogenesis-has recently gained momentum as a model to study ectopic calcification disorders. In this review, we outline the mechanisms of ectopic mineralization in zebrafish, provide insights into zebrafish mutants that share phenotypic similarities with human pathological mineralization disorders, list the compounds capable of rescuing mutant phenotypes, and describe current methods to induce and characterize ectopic calcification in zebrafish.
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Rahul M, Shrivastava N, Tewari N, Mathur V. Dentofacial manifestations of fetal warfarin syndrome in a paediatric patient. BMJ Case Rep 2022; 15:e243890. [PMID: 35039338 PMCID: PMC8768003 DOI: 10.1136/bcr-2021-243890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/04/2022] Open
Abstract
Anticoagulant therapy is commonly indicated during pregnancy to prevent thrombosis and prevention of prosthetic heart valve-associated thromboembolic events. Warfarin is a synthetic anticoagulant with low molecular weight and can cross the placenta resulting in congenital abnormalities termed fetal warfarin syndrome. This paper highlights the case of an 8-year-old boy with warfarin embryopathy. It highlights the extraoral and intraoral findings of the case along with the cephalometric analysis and provides insight into the phenotypic variations among the different cases reported in the literature.
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Affiliation(s)
- Morankar Rahul
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Nikhil Shrivastava
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Vijay Mathur
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
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Payancé A, Ceccaldi PF, De Raucourt E, Valla D, Hillaire S, Dutheil D, Hernandez-Gea V, Bureau C, Plessier A. Pregnancy and vascular liver diseases: Vascular liver diseases: position papers from the francophone network for vascular liver diseases, the French Association for the Study of the Liver (AFEF), and ERN-rare liver. Clin Res Hepatol Gastroenterol 2020; 44:433-437. [PMID: 32278776 DOI: 10.1016/j.clinre.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Audrey Payancé
- DHU Unity, Department of Hepatology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hambourg Germany; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
| | - Pierre François Ceccaldi
- Department of obstetrics and gynecology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Inserm 3PHM « Pathophysiology & Pharmacotoxicology of the Human Placenta, pre & postnatal Microbiota (3PHM)», Faculty of Pharmacy, University of Paris, Paris, France
| | - Emmanuelle De Raucourt
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of haematology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France
| | - Dominique Valla
- DHU Unity, Department of Hepatology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hambourg Germany; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Sophie Hillaire
- Department of Internal Medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Danielle Dutheil
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Association of patients with vascular liver diseases (AMVF), Department of Hepatology, Beaujon Hospital, 100, boulevard du Général Leclerc, 92118 Clichy, France
| | - Virginia Hernandez-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Health Care Provider of the European Reference Network onRare Liver Disorders (ERN-Liver), Spain
| | - Christophe Bureau
- French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| | - Aurélie Plessier
- DHU Unity, Department of Hepatology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; Reference center of vascular liver diseases, European Reference Network (ERN) "Rare-Liver", Hambourg Germany; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
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Marietta M, Coluccio V, Boriani G, Luppi M. Effects of Anti-vitamin k oral anticoagulants on bone and cardiovascular health. Eur J Intern Med 2020; 79:1-11. [PMID: 32553585 DOI: 10.1016/j.ejim.2020.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/21/2020] [Indexed: 12/16/2022]
Abstract
Vitamin K antagonist oral anticoagulants (VKAs) have been proven over 50 years to be highly effective and acceptably safe in many settings and are still used by millions of people worldwide. The main concern about the safety of VKAs regards the risk of bleeding, but there is accumulation evidence of their potentially negative effects beyond hemostasis. Indeed, VKAs impair the action of several Vitamin-K Dependent Proteins (VKDP), such as Bone Gla protein, Matrix Gla protein, Gas6 Protein, Periostin and Gla-Ric Protein, involved in bone and vascular metabolism, thus exerting a detrimental effect on bone and vascular health. Indeed, although the evidence regarding this issue is not compelling, it has been shown that VKAs use decreases bone mass density, increases the risk of bone fractures and accelerates the process of vascular and valvular calcification. Vascular calcification is a major concern in Chronic Kidney Disease (CKD) patients, also in absence of VKAs, because of mineral metabolism derangement, chronic inflammation and oxidative stress. Direct Oral AntiCoagulants (DOACs) do not affect VKDP involved in vascular and valvular calcification, and do not induce calcific valve degeneration in animal models, being a possible alternative to AVK for CKD patients. However, the efficacy and safety of DOACs in this population, suggested by some recent observations, requires confirmation by dedicated, randomized study. We reviewed here the effects of VKAs in bone and vascular health as compared to DOACs, in order to provide the physicians with some data useful to wisely choose the most suitable anticoagulant for every patient.
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Affiliation(s)
- Marco Marietta
- Hematology Unit, Azienda Ospedaliero-Universitaria, Modena, Italy.
| | - Valeria Coluccio
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Mario Luppi
- Hematology Unit, Azienda Ospedaliero-Universitaria, Modena, Italy; Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
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6
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Beato S, Marques C, Laizé V, Gavaia PJ, Fernández I. New Insights on Vitamin K Metabolism in Senegalese sole ( Solea senegalensis) Based on Ontogenetic and Tissue-Specific Vitamin K Epoxide Reductase Molecular Data. Int J Mol Sci 2020; 21:E3489. [PMID: 32429051 PMCID: PMC7278968 DOI: 10.3390/ijms21103489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
Vitamin K (VK) is a key nutrient for several biological processes (e.g., blood clotting and bone metabolism). To fulfill VK nutritional requirements, VK action as an activator of pregnane X receptor (Pxr) signaling pathway, and as a co-factor of γ-glutamyl carboxylase enzyme, should be considered. In this regard, VK recycling through vitamin K epoxide reductases (Vkors) is essential and should be better understood. Here, the expression patterns of vitamin K epoxide reductase complex subunit 1 (vkorc1) and vkorc1 like 1 (vkorc1l1) were determined during the larval ontogeny of Senegalese sole (Solea senegalensis), and in early juveniles cultured under different physiological conditions. Full-length transcripts for ssvkorc1 and ssvkorc1l1 were determined and peptide sequences were found to be evolutionarily conserved. During larval development, expression of ssvkorc1 showed a slight increase during absence or low feed intake. Expression of ssvkorc1l1 continuously decreased until 24 h post-fertilization, and remained constant afterwards. Both ssvkors were ubiquitously expressed in adult tissues, and highest expression was found in liver for ssvkorc1, and ovary and brain for ssvkorc1l1. Expression of ssvkorc1 and ssvkorc1l1 was differentially regulated under physiological conditions related to fasting and re-feeding, but also under VK dietary supplementation and induced deficiency. The present work provides new and basic molecular clues evidencing how VK metabolism in marine fish is sensitive to nutritional and environmental conditions.
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Affiliation(s)
- Silvia Beato
- Campus de Vegazana, Universidad de León (ULE), s/n, 24071 León, Spain;
| | - Carlos Marques
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.M.); (V.L.); (P.J.G.)
| | - Vincent Laizé
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.M.); (V.L.); (P.J.G.)
| | - Paulo J. Gavaia
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; (C.M.); (V.L.); (P.J.G.)
- Departamento de Ciências Biomédicas e Medicina (DCBM), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Ignacio Fernández
- Center for Aquaculture Research, Agrarian Technological Institute of Castile and Leon, Ctra. Arévalo, S/n. Zamarramala, 40196 Segovia, Spain
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7
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Card DJ, Gorska R, Harrington DJ. Laboratory assessment of vitamin K status. J Clin Pathol 2019; 73:70-75. [DOI: 10.1136/jclinpath-2019-205997] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/14/2019] [Accepted: 12/07/2019] [Indexed: 12/14/2022]
Abstract
Vitamin K is required for the ɣ-carboxylation of specific glutamic acid residues within the Gla domain of the 17 vitamin K-dependent proteins (VKDPs). The timely detection and correction of vitamin K deficiency can protect against bleeding. Vitamin K also plays a role in bone metabolism and vascular calcification. Patients at increased risk of vitamin K deficiency include those with a restricted diet or malnutrition, lipid malabsorption, cancer, renal disease, neonates and the elderly. Coagulation assays such as the prothrombin time have been used erroneously as indicators of vitamin K status, lacking sufficient sensitivity and specificity for this application. The measurement of phylloquinone (K1) in serum is the most commonly used marker of vitamin K status and reflects abundance of the vitamin. Concentrations <0.15 µg/L are indicative of deficiency. Disadvantages of this approach include exclusion of the other vitamin K homologues and interference from recent dietary intake. The cellular utilisation of vitamin K is determined through measurement of the prevalence of undercarboxylated VKDPs. Most commonly, undercarboxylated prothrombin (Protein Induced by Vitamin K Absence/antagonism, PIVKA-II) is used (reference range 17.4–50.9 mAU/mL (Abbott Architect), providing a retrospective indicator of hepatic vitamin K status. Current clinical applications of PIVKA-II include supporting the diagnosis of vitamin K deficiency bleeding of the newborn, monitoring exposure to vitamin K antagonists, and when used in combination with α-fetoprotein, as a diagnostic marker of hepatocellular carcinoma. Using K1 and PIVKA-II in tandem is an approach that can be used successfully for many patient cohorts, providing insight into both abundance and utilisation of the vitamin.
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8
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Granadeiro L, Dirks RP, Ortiz-Delgado JB, Gavaia PJ, Sarasquete C, Laizé V, Cancela ML, Fernández I. Warfarin-exposed zebrafish embryos resembles human warfarin embryopathy in a dose and developmental-time dependent manner - From molecular mechanisms to environmental concerns. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 181:559-571. [PMID: 31238190 DOI: 10.1016/j.ecoenv.2019.06.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
Warfarin is the most worldwide used anticoagulant drug and rodenticide. Since it crosses placental barrier it can induce warfarin embryopathy (WE), a fetal mortality in neonates characterized by skeletal deformities in addition to brain hemorrhages. Although the effects of warfarin exposure in aquatic off target species were already described, the particular molecular toxicological mechanisms during early development are still unclear. Here, we used zebrafish (Danio rerio) to describe and compare the developmental effects of warfarin exposure (0, 15.13, 75.68 and 378.43 mM) on two distinct early developmental phases (embryos and eleuthero-embryos). Although exposure to both developmental phases induced fish mortality, only embryos exposed to the highest warfarin level exhibited features mimicking mammalian WE, e.g. high mortality, higher incidence of hemorrhages and altered skeletal development, among other effects. To gain insights into the toxic mechanisms underlying warfarin exposure, the transcriptome of embryos exposed to warfarin was explored through RNA-Seq and compared to that of control embryos. 766 differentially expressed (564 up- and 202 down-regulated) genes were identified. Gene Ontology analysis revealed particular cellular components (cytoplasm, extracellular matrix, lysosome and vacuole), biological processes (mainly amino acid and lipid metabolism and response to stimulus) and pathways (oxidative stress response and apoptosis signaling pathways) being significantly overrepresented in zebrafish embryos upon warfarin exposure. Protein-protein interaction further evidenced an altered redox system, blood coagulation and vasculogenesis, visual phototransduction and collagen formation upon warfarin exposure. The present study not only describes for the first time the WE in zebrafish, it provides new insights for a better risk assessment, and highlights the need for programming the rat eradication actions outside the fish spawning season to avoid an impact on off target fish community. The urge for the development of more species-specific anticoagulants for rodent pest control is also highlighted.
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Affiliation(s)
- Luis Granadeiro
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Ron P Dirks
- ZF-screens B.V. J.H. Oortweg 19, 2333, CH Leiden, the Netherlands
| | - Juan B Ortiz-Delgado
- Instituto de Ciencias Marinas de Andalucía-ICMAN/CSIC, Campus Universitario Río San Pedro, Apdo. Oficial, 11510, Puerto Real, Cádiz, Spain
| | - Paulo J Gavaia
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; Departamento de Ciências Biomédicas e Medicina (DCBM), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Carmen Sarasquete
- Instituto de Ciencias Marinas de Andalucía-ICMAN/CSIC, Campus Universitario Río San Pedro, Apdo. Oficial, 11510, Puerto Real, Cádiz, Spain
| | - Vincent Laizé
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - M Leonor Cancela
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; Departamento de Ciências Biomédicas e Medicina (DCBM), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; Algarve Biomedical Center (ABC) and Centre for Biomedical Research (CBMR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Ignacio Fernández
- Centro de Ciências do Mar (CCMAR), Universidade do Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; Center for Aquaculture Research, Agrarian Technological Institute of Castile and Leon, Ctra. Arévalo, S/n. 40196 Zamarramala, Segovia, Spain.
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Dhillon SK, Edwards J, Wilkie J, Bungard TJ. High-Versus Low-Dose Warfarin-Related Teratogenicity: A Case Report and Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1348-1357. [PMID: 30390948 DOI: 10.1016/j.jogc.2017.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The optimal anticoagulant therapy during pregnancy in women with mechanical heart valves remains controversial. This study highlights a case of high-dose warfarin ingestion throughout pregnancy and performed a systematic review to assess rates of teratogenicity with high versus low warfarin dosing (≤5 mg daily). METHODS A literature search for all case reports and available literature was conducted in PubMed, Medline, and EMBASE up to December 2016 using medical subject heading terms "mechanical prosthetic valves," "pregnancy," "oral anticoagulants," "warfarin," "coumarins," "heparin, low-molecular-weight," and "thromboembolism." To be included, warfarin had to be administered anytime between 6 and 12 weeks of gestation with the dose being specified. The Newcastle-Ottawa Scale was used to assess quality of the cohort data. RESULTS The woman in the studied case received the highest reported warfarin doses throughout pregnancy (14.5-16.5 mg daily) and delivered a baby with no evidence of teratogenicity to the current age of 5 years. The study identified 23 case reports, with all demonstrating warfarin teratogenicity regardless of high-dose (n = 12) or low-dose (n = 11) warfarin. Twelve cohort studies identified a warfarin teratogenicity rate of 5.0%, with rates of 2.4% and 10.5% with low- and high-dose warfarin, respectively. Risk of bias was moderate (median Newcastle-Ottawa Scale score of 6) for all of the cohort studies. CONCLUSION Although a lower prevalence of warfarin-induced teratogenicity is reported with low-dose warfarin, a safe "cut-off" dose is misleading. Teratogenic risk with warfarin is unpredictable, mandating individual decisions regardless of the dose.
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Affiliation(s)
| | | | | | - Tammy J Bungard
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB.
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Yaqoob M, Feinstein DL, Rubinstein I. Pregnancy in Women With Life-Threatening Poisoning With Long-Acting Anticoagulant Rodenticides. Mayo Clin Proc 2019; 94:1646-1647. [PMID: 31378241 DOI: 10.1016/j.mayocp.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/16/2019] [Accepted: 05/14/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Maidah Yaqoob
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, and Department of Anesthesiology, University of Illinois at Chicago Jesse Brown Veterans Affair Medical Center, Chicago, IL
| | - Douglas L Feinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, and Department of Anesthesiology, University of Illinois at Chicago Jesse Brown Veterans Affair Medical Center, Chicago, IL
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, and Department of Anesthesiology, University of Illinois at Chicago Jesse Brown Veterans Affair Medical Center, Chicago, IL
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11
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Tole M, LaBedz S, Feinstein DL, Rubinstein I. Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago. Lung 2019; 197:349-352. [PMID: 31004190 DOI: 10.1007/s00408-019-00227-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 12/27/2022]
Abstract
A large-scale outbreak of life-threatening, inhaled synthetic cannabinoids (Spice/K2)-associated coagulopathy with bleeding complications was recently reported in Illinois. The causative agents were brodifacoum, difenacoum, and bromadiolone, potent, long-acting, 4-hydroxycoumarin anticoagulant rodenticides (LAAR) that were mixed with Spice/K2 products procured and then inhaled by the victims. We report on 3 poisoned patients who reside in underserved, socioeconomically disadvantaged neighborhoods of Chicago that were admitted and treated successfully at two inner-city, tertiary care hospitals in Chicago. The patients were discharged from the hospitals on daily long-term high-dose oral vitamin K1 (VK1), provided free of charge. However, 2 patients were lost to follow-up prior to safe discontinuation of oral VK1 therapy. The third patient was treated and followed successfully for 7 months when VK1 was discontinued. We conclude that prolonged oral VK1 therapy and follow-up of acute, life-threatening LAAR poisoning are variable and present challenges to healthcare providers. Appropriate practice guidelines to improve patient access and adherence to daily high-dose oral VK1 therapy and follow-up should be developed and implemented.
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Affiliation(s)
- Mateo Tole
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine (M/C 719), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.,Medical Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA
| | - Stephanie LaBedz
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine (M/C 719), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.,Medical Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA
| | - Douglas L Feinstein
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, 60612, USA.,Research and Development Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine (M/C 719), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA. .,Medical Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA. .,Research and Development Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA.
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12
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Teng YKO, Bredewold EOW, Rabelink TJ, Huizinga TWJ, Eikenboom HCJ, Limper M, Fritsch-Stork RDE, Bloemenkamp KWM, Sueters M. An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus. Rheumatology (Oxford) 2018; 57:1707-1720. [PMID: 29165607 DOI: 10.1093/rheumatology/kex374] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Indexed: 12/17/2022] Open
Abstract
Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification. Therefore the present review specifically addresses the issue of pre-pregnancy counselling for SLE patients with an evidence-based approach. The review summarizes data retrieved from recently published, high-quality cohort studies that have contributed to a better understanding and estimation of pregnancy-related risks for SLE patients. The present review categorizes risks from a patient-oriented point of view, that is, the influence of pregnancy on SLE, of SLE on pregnancy, of SLE on the foetus/neonate and of SLE-related medication. Lastly, pre-pregnancy counselling of SLE patients with additional secondary APS is reviewed. Collectively these data can guide clinicians to formulate appropriate preventive strategies and patient-tailored monitoring plans during pre-pregnancy counselling of SLE patients.
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Affiliation(s)
- Y K Onno Teng
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edwin O W Bredewold
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - H C Jeroen Eikenboom
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruth D E Fritsch-Stork
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,1st Medical Department & Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, Hanusch Hospital.,Sigmund Freud University, Vienna, Austria
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Sueters
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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13
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Ho VT, Dua A, Lavingia K, Rothenberg K, Rao C, Desai SS. Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review. Vasc Endovascular Surg 2018; 52:527-534. [PMID: 29804522 DOI: 10.1177/1538574418777822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. METHODS A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. RESULTS A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy. For systemic thrombolysis, the maternal complication rate was 4.40% and the fetal complication rate was 1.65%. For catheter-directed thrombolysis, the maternal complication rate was 14.75% and the fetal complication rate was 5.2%. In cases of mechanical thrombectomy, there were no reported maternal or fetal complications. CONCLUSIONS Although conservative strategies are preferred in pregnancy, thrombolysis is an adjunct for limb or life-threatening VTE. Review of past reports suggests low rates of maternal and fetal complications following systemic thrombolysis and mechanical thrombectomy but higher rates of complications after catheter-directed thrombolysis in the treatment of VTE during pregnancy.
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Affiliation(s)
- Vy T Ho
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Anahita Dua
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kedar Lavingia
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kara Rothenberg
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA.,2 Department of Surgery, University of California San Francisco-East Bay, San Francisco, CA, USA
| | - Christina Rao
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
| | - Sapan S Desai
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
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14
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Popov Aleksandrov A, Mirkov I, Ninkov M, Mileusnic D, Demenesku J, Subota V, Kataranovski D, Kataranovski M. Effects of warfarin on biological processes other than haemostasis: A review. Food Chem Toxicol 2018; 113:19-32. [PMID: 29353071 DOI: 10.1016/j.fct.2018.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/29/2017] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
Warfarin is the world's most widely used anticoagulant drug. Its anticoagulant activity is based on the inhibition of the vitamin K-dependent (VKD) step in the complete synthesis of a number of blood coagulation factors that are required for normal blood coagulation. Warfarin also affects synthesis of VKD proteins not related to haemostasis including those involved in bone growth and vascular calcification. Antithrombotic activity of warfarin is considered responsible for some aspects of its anti-tumour activity of warfarin. Some aspects of activities against tumours seem not to be related to haemostasis and included effects of warfarin on non-haemostatic VKD proteins as well as those not related to VKD proteins. Inflammatory/immunomodulatory effects of warfarin indicate much broader potential of action of this drug both in physiological and pathological processes. This review provides an overview of the published data dealing with the effects of warfarin on biological processes other than haemostasis.
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Affiliation(s)
- Aleksandra Popov Aleksandrov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Ivana Mirkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Marina Ninkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Dina Mileusnic
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Jelena Demenesku
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia
| | - Vesna Subota
- Institute for Medical Biochemistry, Military Medical Academy, 17 Crnotravska, 11000 Belgrade, Serbia
| | - Dragan Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia; Institute of Zoology, Faculty of Biology, University of Belgrade, 16 Studentski trg, 11000 Belgrade, Serbia
| | - Milena Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar Despota Stefana, 11000 Belgrade, Serbia; Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, 16 Studentski trg, 11000 Belgrade, Serbia.
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15
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Marulanda J, Eimar H, McKee MD, Berkvens M, Nelea V, Roman H, Borrás T, Tamimi F, Ferron M, Murshed M. Matrix Gla protein deficiency impairs nasal septum growth, causing midface hypoplasia. J Biol Chem 2017; 292:11400-11412. [PMID: 28487368 PMCID: PMC5500805 DOI: 10.1074/jbc.m116.769802] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/01/2017] [Indexed: 12/31/2022] Open
Abstract
Genetic and environmental factors may lead to abnormal growth of the orofacial skeleton, affecting the overall structure of the face. In this study, we investigated the craniofacial abnormalities in a mouse model for Keutel syndrome, a rare genetic disease caused by loss-of-function mutations in the matrix Gla protein (MGP) gene. Keutel syndrome patients show diffuse ectopic calcification of cartilaginous tissues and impaired midface development. Our comparative cephalometric analyses of micro-computed tomography images revealed a severe midface hypoplasia in Mgp-/- mice. In vivo reporter studies demonstrated that the Mgp promoter is highly active at the cranial sutures, cranial base synchondroses, and nasal septum. Interestingly, the cranial sutures of the mutant mice showed normal anatomical features. Although we observed a mild increase in mineralization of the spheno-occipital synchondrosis, it did not reduce the relative length of the cranial base in comparison with total skull length. Contrary to this, we found the nasal septum to be abnormally mineralized and shortened in Mgp-/- mice. Transgenic restoration of Mgp expression in chondrocytes fully corrected the craniofacial anomalies caused by MGP deficiency, suggesting a local role for MGP in the developing nasal septum. Although there was no up-regulation of markers for hypertrophic chondrocytes, a TUNEL assay showed a marked increase in apoptotic chondrocytes in the calcified nasal septum. Transmission electron microscopy confirmed unusual mineral deposits in the septal extracellular matrix of the mutant mice. Of note, the systemic reduction of the inorganic phosphate level was sufficient to prevent abnormal mineralization of the nasal septum in Mgp-/-;Hyp compound mutants. Our work provides evidence that modulation of local and systemic factors regulating extracellular matrix mineralization can be possible therapeutic strategies to prevent ectopic cartilage calcification and some forms of congenital craniofacial anomalies in humans.
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Affiliation(s)
- Juliana Marulanda
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hazem Eimar
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Marc D McKee
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
- the Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Michelle Berkvens
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Valentin Nelea
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hassem Roman
- the Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec H3A 0C7, Canada
- the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Teresa Borrás
- the Department of Ophthalmology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27516
| | - Faleh Tamimi
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Mathieu Ferron
- the Institut de Recherches Cliniques de Montréal, Montréal, Quebec H2W 1R7, Canada, and
| | - Monzur Murshed
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada,
- the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
- the Shriners Hospital for Children, Montreal, Quebec H4A 0A9, Canada
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16
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Donaldson CJ, Harrington DJ. Therapeutic warfarin use and the extrahepatic functions of vitamin K-dependent proteins. Br J Biomed Sci 2017; 74:163-169. [PMID: 28657840 DOI: 10.1080/09674845.2017.1336854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The impact of warfarin therapy on the functions of extrahepatic vitamin K-dependent proteins (VKDP) is less clearly understood and less widely recognised in clinical practice than that on the hepatic counterparts (clotting factors II, VII, IX and X). Warfarin inhibits osteocalcin, an abundant extrahepatic VKDP involved in the mineralisation and maturation of bone and thus, primarily by this mechanism, may have an adverse effect on bone health. Whilst some studies do link warfarin use to an increase in osteoporosis and fracture risk others have not. Warfarin also inhibits the extrahepatic VKDP matrix gla protein (MGP) which acts to prevent ectopic calcification of the vasculature. Studies have consistently found a correlation between warfarin use and vascular calcification with inhibition of MGP believed to be the main cause. Inhibition of MGP also appears to explain warfarin's well established teratogenic effect. Further adverse effects may also arise from warfarin's inhibition of other known extrahepatic VKDPs. The available evidence is intriguing, and suggests that the impact of warfarin on the extrahepatic functions of vitamin K-dependent proteins warrants further careful consideration.
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Affiliation(s)
- C J Donaldson
- a Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - D J Harrington
- b The Nutristasis Unit, Viapath, St. Thomas' Hospital , London , UK.,c Division of Women's Health , School of Medicine, King's College London , London , UK
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17
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Targeted nanoparticles in pregnancy: a new frontier in perinatal therapeutics. Am J Obstet Gynecol 2017; 216:204-205. [PMID: 28161454 DOI: 10.1016/j.ajog.2017.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/06/2017] [Accepted: 01/18/2017] [Indexed: 11/20/2022]
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18
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Prenatal exposure to environmental factors and congenital limb defects. ACTA ACUST UNITED AC 2016; 108:243-273. [DOI: 10.1002/bdrc.21140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/26/2022]
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19
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Beyer-Westendorf J, Michalski F, Tittl L, Middeldorp S, Cohen H, Abdul Kadir R, Arachchillage DJ, Arya R, Ay C, Marten S. Pregnancy outcome in patients exposed to direct oral anticoagulants - and the challenge of event reporting. Thromb Haemost 2016; 116:651-8. [PMID: 27384740 DOI: 10.1160/th16-04-0305] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/25/2016] [Indexed: 11/05/2022]
Abstract
Today, direct oral anticoagulants (DOAC) are widely used alternatives to Vitamin-K antagonists (VKA). Women of reproductive age may become pregnant during anticoagulation and, while VKA carry an embryotoxic potential, the risk of DOAC embryopathy is unknown. As a result, some patients elect to terminate pregnancy for fear of DOAC embryotoxicity. To assess the risk of DOAC embryopathy, we reviewed cases of DOAC exposure in pregnancy collected from physicians, literature and pharmacovigilance systems of drug authorities and manufacturers. A total of 357 reports including duplicates were available from which 233 unique cases could be identified. Information on pregnancy outcome was available in only 137/233 cases (58.8 %): 67 live births (48.9 %); 31 miscarriages (22.6 %); 39 elective pregnancy terminations (28.5 %). In 93 cases (39.9 %) no outcome data were available (including 3 cases of ongoing pregnancy). Of the 137 pregnancies with reported outcomes, seven showed abnormalities (5.1 %) of which three (2.2 %) could potentially be interpreted as embryopathy: live birth with facial dysmorphism; miscarriage in week 10 with limb abnormality; elective pregnancy termination due to a foetal cardiac defect in a woman who had to terminate a previous pregnancy due to Fallot tetralogy. Within its limitations (small numbers, incomplete outcome data) our results do not indicate that DOAC exposure in pregnancy carries a high risk of embryopathy or that DOAC exposure per se should be used to direct patient counselling towards pregnancy termination. Pregnancy outcome data are inconsistently captured in pharmacovigilance databases indicating the strong need for a more robust system of reporting.
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Affiliation(s)
- Jan Beyer-Westendorf
- Jan Beyer-Westendorf, Center for Vascular Medicine and Department of Medicine III, Division of Angiology University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74; 01307 Dresden, Germany, Tel.: +49 351 4583659, Fax: +49 531 4584359, E-mail:
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20
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Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg 2016; 122:786-804. [DOI: 10.1213/ane.0000000000001143] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Warkus ELL, Yuen AAYQ, Lau CGY, Marikawa Y. Use ofIn VitroMorphogenesis of Mouse Embryoid Bodies to Assess Developmental Toxicity of Therapeutic Drugs Contraindicated in Pregnancy. Toxicol Sci 2015; 149:15-30. [DOI: 10.1093/toxsci/kfv209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis. Case Rep Obstet Gynecol 2015; 2015:987940. [PMID: 26078896 PMCID: PMC4452844 DOI: 10.1155/2015/987940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 11/19/2022] Open
Abstract
Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia.
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23
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Silveira DB, da Rosa EB, de Mattos VF, Goetze TB, Sleifer P, Santa Maria FD, Rosa RCM, Rosa RFM, Zen PRG. Importance of a multidisciplinary approach and monitoring in fetal warfarin syndrome. Am J Med Genet A 2015; 167:1294-9. [PMID: 25899236 DOI: 10.1002/ajmg.a.36655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/26/2014] [Indexed: 11/12/2022]
Abstract
Warfarin is a synthetic oral anticoagulant that crosses the placenta and can lead to a number of congenital abnormalities known as fetal warfarin syndrome. Our aim is to report on the follow-up from birth to age 8 years of a patient with fetal warfarin syndrome. He presented significant respiratory dysfunction, as well as dental and speech and language complications. The patient was the second child of a mother who took warfarin during pregnancy due to a metallic heart valve. The patient had respiratory dysfunction at birth. On physical examination, he had a hypoplastic nose, pectus excavatum, and clubbing of the fingers. Nasal fibrobronchoscopy showed upper airway obstruction due to narrowing of the nasal cavities. He underwent surgical correction with Max Pereira graft, zetaplasty, and osteotomies for the piriform aperture. At dental evaluation, he had caries and delayed eruption of the upper incisors. Speech and language assessment revealed high palate, mouth breathing, little nasal patency, and shortened upper lip. Auditory long latency and cognitive-related potential to auditory stimuli demonstrated functional changes in the cortical auditory pathways. We believe that the frequency of certain findings observed in our patient may be higher in fetal warfarin syndrome than is appreciated, since a significant number result in abortions, stillbirths, or children evaluated in the first year of life without a follow-up. Thus, a multidisciplinary approach and long-term monitoring of these patients may be necessary.
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Affiliation(s)
- Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Graduation in Nursing, UFCSPA, RS, Brazil
| | | | - Vinicius F de Mattos
- Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil
| | - Thayse B Goetze
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Pricila Sleifer
- Speech Language Pathology, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - Fernanda D Santa Maria
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Rosana C M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil.,Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil
| | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil
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24
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Fernández I, Santos A, Cancela ML, Laizé V, Gavaia PJ. Warfarin, a potential pollutant in aquatic environment acting through Pxr signaling pathway and γ-glutamyl carboxylation of vitamin K-dependent proteins. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2014; 194:86-95. [PMID: 25094061 DOI: 10.1016/j.envpol.2014.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/04/2014] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
Warfarin-induced vitamin K (VK) recycling impairment is used worldwide as a rodenticide and human thromboembolic prophylactic. Since VK metabolism/signaling pathways have been conserved throughout vertebrate evolution, its release to the environment might impact on aquatic organisms. Present study assessed the toxic effect of warfarin (0, 5, 25 and 125 mg L(-1)) on zebrafish development and characterized underlying mechanisms of action through qPCR analysis of VK-related genes. Expression of pregnane X receptor (pxr), the nuclear receptor binding vitamin K, was ubiquitous in zebrafish and suggests that warfarin exposure may interfere with several biological processes. Indeed, warfarin exposure of zebrafish larvae caused hemorrhages in brain, skeletal deformities and triggered ectopic calcifications, which may be the consequence of an altered γ-carboxylation of VK-dependent proteins and/or pxr signaling. This study provides new insights into warfarin effects as a bone homeostasis disruptor and soft tissue calcification inductor, and its potential risk for aquatic environments.
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Affiliation(s)
- Ignacio Fernández
- Centre of Marine Sciences (CCMAR), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal.
| | - Adriana Santos
- Centre of Marine Sciences (CCMAR), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - M Leonor Cancela
- Centre of Marine Sciences (CCMAR), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal; Department of Biomedical Sciences and Medicine (DCBM), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Vincent Laizé
- Centre of Marine Sciences (CCMAR), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
| | - Paulo J Gavaia
- Centre of Marine Sciences (CCMAR), University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal
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25
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Königsbrügge O, Langer M, Hayde M, Ay C, Pabinger I. Oral anticoagulation with rivaroxaban during pregnancy: a case report. Thromb Haemost 2014; 112:1323-4. [PMID: 25055834 DOI: 10.1160/th14-04-0393] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/12/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - I Pabinger
- Prof. Dr. Ingrid Pabinger, Medical University of Vienna, Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 44480, Fax: +43 1 40400 40300, E-mail:
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26
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Abstract
Ischemic stroke is uncommon during pregnancy, but decision making for acute revascularization therapy including intravenous recombinant tissue plasminogen activator (rt-PA) is difficult. The use of rt-PA remains controversial, but a systematic review of 16 patients (mean age 31.7 years) showed good results for both maternal (77.8%) and fetal (56.3%) outcomes. Pregnancy alone is not a solid contraindication for acute revascularization therapy including rt-PA. An endovascular approach might be beneficial for reducing the hemorrhagic complication; however, the treatment strategy should be considered based on the available treatment facility. Close cooperation with obstetrics is essential for the successful management of saving the lives of both the mother and the fetus.
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Affiliation(s)
- Teruyuki Hirano
- Department of Neurology, Oita University Faculty of Medicine, Yufu, Oita, Japan.
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27
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Swan L. Congenital heart disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:495-506. [PMID: 24675221 DOI: 10.1016/j.bpobgyn.2014.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
The story of congenital heart disease is one of the major successes of medicine in the last 50 years. Heart conditions previously associated with early death are now successfully treated. Many of these women are now in their child-bearing years wishing to have children of their own. All of these women should be offered comprehensive pre-conception counselling by a dedicated multi-disciplinary team. Each woman will present a unique set of cardiac and obstetric challenges that require an individualised assessment of risk and a carefully documented care plan. In this chapter, I describe the most common forms of congenital heart disease and the specific issues that should be assessed before conception. I present a systematic approach to risk stratification and care planning. These lesions range from mild disease with little implications for pregnancy to those with a sizable risk of maternal mortality or complications. I will also discuss fetal risk factors.
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Affiliation(s)
- Lorna Swan
- Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK.
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28
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29
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Alonso-Gonzalez R, Swan L. Treating Cardiac Disease in Pregnancy. WOMENS HEALTH 2014; 10:79-88; quiz 89-90. [DOI: 10.2217/whe.13.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Maternal cardiac disease is a very significant cause of both maternal morbidity and mortality in westernized countries. An effective treatment program must tackle all of the contributing components, including those due to public health issues, poorly coordinated healthcare systems and inadequate medical education. Even with optimal care, many of these patients remain at high risk. In this setting, it is the role of the multidisciplinary team to counsel women regarding these risks and to proactively institute treatment algorithms that will optimize maternal and fetal outcomes.
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Affiliation(s)
| | - Lorna Swan
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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Castellano JM, Narayan RL, Vaishnava P, Fuster V. Anticoagulation during pregnancy in patients with a prosthetic heart valve. Nat Rev Cardiol 2012; 9:415-24. [DOI: 10.1038/nrcardio.2012.69] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Liu Y, Sun Y, Zhang S, Jin X. Placement of a retrievable inferior vena cava filter for deep venous thrombosis in term pregnancy. J Vasc Surg 2012; 55:1042-7. [DOI: 10.1016/j.jvs.2011.10.107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022]
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The Search for a Safe and Effective Anticoagulation Regimen in Pregnant Women With Mechanical Prosthetic Heart Valves⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology. J Am Coll Cardiol 2012; 59:1116-8. [DOI: 10.1016/j.jacc.2011.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 11/19/2022]
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Hauck B, Zimmermann R, Ringwald J, Goecke TW, Beckmann MW, Cupisti S, Eckstein R. Pregnancy outcome after maternal intoxication with phenprocoumon. Br J Clin Pharmacol 2010; 71:139-40. [PMID: 21143512 DOI: 10.1111/j.1365-2125.2010.03809.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Warfarin embryopathy: fetal manifestations. Virchows Arch 2010; 457:735-9. [PMID: 20922410 DOI: 10.1007/s00428-010-0982-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 09/01/2010] [Accepted: 09/20/2010] [Indexed: 10/19/2022]
Abstract
During the period 1991-2007, autopsy was undertaken in 13 fetuses with warfarin embryopathy. Pregnancy data and radiographic babygrams were available in each instance. Gestational age ranged from 17 to 37 weeks. Eleven of the fetuses had the characteristic nasal hypoplasia, but only three had radiological epiphyseal stippling. Cerebral hemorrhage was a major feature of autopsy in 8 of the fetuses, and it is evident that bleeding is a significant factor in the pathogenesis of warfarin embryopathy. A wide variety of additional visceral manifestations which were observed at autopsy have been tabulated. There was no obvious correlation between maternal or gestational age and the presence and severity of any specific embryopathic feature. No information was available concerning the dose and timing of warfarin administration in this series.
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HEPARIN IN HUMAN PLACENTAL DEVELOPMENT AND THE PREVENTION OF PLACENTAL COMPLICATIONS OF PREGNANCY. ACTA ACUST UNITED AC 2010. [DOI: 10.1017/s0965539510000070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The development of effective anticoagulant drugs available for use in pregnancy has resulted in dramatic improvements for a number of potentially life-threatening conditions. These include the treatment and prevention of venous thromboembolism and the thrombotic complications of antiphospholipid antibody syndrome, as well as the management of pregnant women with mechanical heart valves. The most commonly used class of drug includes heparin, a highly-charged macro-molecule that does not cross the placenta, in contrast to the potentially teratogenic and fetotoxic oral drug warfarin. This review will focus on our current lack of understanding of the wider actions of heparin and examines the possibility that large numbers of pregnant women are presently being treated inappropriately with heparin.
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