Management of pregnant women with artificial heart valves: inconsistency in ESC publications.
نویسنده
چکیده
I read with interest the ESC position paper on anticoagulants in heart disease. However, I was surprised by the succinct statement on anticoagulation in pregnant patients with artificial heart valves. Vitamin K antagonists increase the risk of embryopathy, whereas the use of unfractionated heparin has been associated with an increased thromboembolic risk for the mother. Experience with low molecular weight heparin is still limited. The risk of warfarin embryopathy is probably dose-dependent. The current ESC guideline on management of valvular heart disease published in this journal in January 2007 therefore favours the use of warfarin during the first trimester if the dose is 5 mg/24 h. This recommendation is in line with an older ESC consensus document published in 2003. The management of pregnant women with artificial heart valves using low molecular weight heparin proposed in the paper by De Caterina et al. deviates from these ESC guidelines without any further explanation. Interestingly, even the cited recommendations by Butchart et al. published in 2005 strongly favour the use of oral anticoagulation throughout pregnancy. However, the policy suggested in the ESC position paper by De Caterina et al. is in line with current AHA recommendations. The optimal management of pregnant women with artificial heart valves is discussed controversially and often poses a challenge to both physicians and patients involved. Because clinicians rely on guidelines and expert recommendations, it is important to establish consistency within publications by ESC task forces and working groups. However, in case of controversial opinions, these should be discussed.
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BACKGROUND Anticoagulation for mechanical heart valves during pregnancy is essential to prevent thromboembolic events. Each regimen has drawbacks with regard to maternal or fetal risk. OBJECTIVES This meta-analysis sought to estimate and compare the risk of adverse maternal and fetal outcomes in pregnant women with mechanical heart valves who received different methods of anticoagulation. M...
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عنوان ژورنال:
- European heart journal
دوره 28 19 شماره
صفحات -
تاریخ انتشار 2007