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Umetsu M, Akamatsu D, Serizawa F, Tajima Y, Suzuki S, Horii S, Ogasawara N, Takahashi H, Nagaoka Y, Shimizu K, Kimura S, Hashimoto M, Goto H, Watanabe T, Kamei T. Anticoagulation Therapy for Pregnancy-Associated Thrombosis: A Retrospective Observational Study. Ann Vasc Dis 2022; 15:317-323. [PMID: 36644260 PMCID: PMC9816033 DOI: 10.3400/avd.oa.22-00083] [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: 07/31/2022] [Accepted: 10/23/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: Pregnancy-associated deep vein thrombosis (DVT) is a rare disease, and data on anticoagulation therapy are lacking. The present study examined the treatment outcome with unfractionated heparin (UFH) subcutaneous injection in patients with pregnancy-associated DVT. Methods: This single-center, retrospective, observational study enrolled 15 patients with pregnancy-associated DVT treated from January 2014 to April 2021. Results: The median age was 35 years. The median gestation week at onset was 10 (interquartile range is 8-11). All patients presented with painful symptoms with edema. All patients had proximal DVT. Anticoagulation therapy using UFH was performed in 14 patients. The median continuous dose of heparin was 18,750 U/day, and the median subcutaneous dose was 20,000 U/day. During the outpatient period, the values of activated partial thromboplastin time fluctuated wildly, but the fibrin monomer complex level remained consistently low. There were two mild bleeding complications, but neither prevented the continuation of anticoagulation therapy. During delivery, thrombi were not detected in 10 of 13 patients (77%), whereas three patients (23%) exhibited regression without resolution of the thrombus. Conclusion: Anticoagulation using UFH subcutaneous injection was safely performed in patients with pregnancy-associated DVT without serious complications or progression of thrombosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kota Shimizu
- Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | | | - Hitoshi Goto
- South Miyagi Medical Center, Shibata, Miyagi, Japan
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Kai S, Fujita Y, Sato Y, Kido S, Hidaka N, Sakamoto I, Kato K. Pregnancy managed by unfractionated heparin after mechanical aortic valve replacement. J Matern Fetal Neonatal Med 2018; 33:1030-1032. [PMID: 30231658 DOI: 10.1080/14767058.2018.1512573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pregnancy after mechanical valve replacement involves high risk. Maternal valve thrombosis and hemorrhagic complications are associated with lethal outcomes; therefore, strict anticoagulant therapy is needed. Our patient was 26-year-old primiparous woman. She had undergone aortic valve replacement with a mechanical valve at 4 years of age and had used warfarin 3 mg per day since then. Because of her desire for a baby, she stopped warfarin and conceived spontaneously. She was referred to our hospital. After being informed of her choices, unfractionated heparin (UFH) administration was started. She experienced mild heart failure with sacroiliitis, bacteremia, and hematuria during pregnancy. She delivered her newborn at 37 weeks. Blood loss at delivery was 220 g. Administration of UFH was restarted 4 h after delivery and 3 mg of warfarin was administered from postpartum day (PPD) 6. Hemostatic suturing was required for vaginal bleeding on PPD7. A therapeutic dose of warfarin was achieved on PPD9. Although warfarin use is recommended as anticoagulant therapy for pregnant woman with mechanical valves, the safety and efficacy of UFH have not yet been clarified because of its limited use. More cases are needed to clarify this.
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Affiliation(s)
- Shotaro Kai
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuyuki Fujita
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
| | - Yuka Sato
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
| | - Saki Kido
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Japan
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Lu CW, Shih JC, Chen SY, Chiu HH, Wang JK, Chen CA, Chiu SN, Lin MT, Lee CN, Wu MH. Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease. Circ J 2015; 79:1609-17. [DOI: 10.1253/circj.cj-14-1368] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital
- Adult Congenital Heart Center, National Taiwan University Hospital
| | - Jin-Chung Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital
| | - Ssu-Yuan Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital
| | - Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital
- Adult Congenital Heart Center, National Taiwan University Hospital
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