Patient Management with Metallic Valve Prosthesis during Pregnancy and Postpartum Period

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Citações na Scopus
2
Tipo de produção
article
Data de publicação
2015
Editora
ARQUIVOS BRASILEIROS CARDIOLOGIA
DOI
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Scopus
Web of Science
PubMed
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Autor de Grupo de pesquisa
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Citação
ARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.105, n.4, p.426-429, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Prosthetic thrombosis is a rare complication, but it has high mortality and morbidity. Young women of childbearing age that have prosthetic heart valves are at increased risk of thrombosis during pregnancy due to changes in coagulation factors. Anticoagulation with adequate control and frequent follow-up if pregnancy occurs must be performed in order to prevent complications related to anticoagulant use. Surgery remains the treatment of choice for prosthetic heart valve thrombosis in most clinical conditions. Patients with metallic prosthetic valves have an estimated 5% risk of thrombosis during pregnancy and maternal mortality of 1.5% related to the event. Anticoagulation with vitamin K antagonists during pregnancy is related to varying degrees of complications at each stage of the pregnancy and postpartum periods. Warfarin sodium crosses the placental barrier and when used in the first trimester of pregnancy is a teratogenic agent, causing 1-3% of malformations characterized by fetal warfarin syndrome and also constitutes a major cause of miscarriage in 10-30% of cases. In the third trimester and at delivery, the use of warfarin is associated with maternal and neonatal bleeding in approximately 5 to 15% of cases, respectively. On the other hand, inadequate anticoagulation, including the suspension of the oral anticoagulants aiming at fetal protection, carries a maternal risk of about 25% of metallic prosthesis thrombosis, particularly in the mitral valve. This fact is also due to the state of maternal hypercoagulability with activation of coagulation factors V, VI, VII, IX, X, platelet activity and fibrinogen synthesis, and decrease in protein S levels. The Registry of Pregnancy and Cardiac Disease (ROPAC), assessing 212 pregnant women with metal prosthesis, showed that prosthesis thrombosis occurred in 10 (4.7%) patients and maternal hemorrhage in 23.1%, concluding that only 58% of patients with metallic prosthesis had a complication-free pregnancy(1-7).
Palavras-chave
Heart Valve Prosthesis, Thrombosis, Anticoagulants / therapeutic use, Pregnancy, Mortality, Abortion, Spontaneous, Próteses Valvares Cardíacas, Trombose, Anticoagulantes / uso terapêutico, Gravidez, Mortalidade, Aborto Espontâneo
URI
https://observatorio.fm.usp.br/handle/OPI/12649
Referências
  1. AI Ramos, 2003, ARQ BRAS CARDIOL, V81, P387
  2. Ramos Auristela I O, 2003, Arq Bras Cardiol, V81, P393, DOI 10.1590/S0066-782X2003001200006
  3. Chan WS, 2000, ARCH INTERN MED, V160, P191, DOI 10.1001/archinte.160.2.191
  4. McLintock C, 2013, THROMB RES, V131, pS8, DOI 10.1016/S0049-3848(13)70010-0
  5. Regitz-Zagrosek V, 2011, EUR HEART J, V32, P3147, DOI 10.1093/eurheartj/ehr218
  6. SBAROUNI E, 1994, BRIT HEART J, V71, P196
  7. Roudaut R, 2009, ARCH CARDIOVASC DIS, V102, P269, DOI 10.1016/j.acvd.2009.01.007
  8. Tong AT, 2004, J AM COLL CARDIOL, V43, P77, DOI 10.1016/j.jacc.2003.08.028
  9. Caceres-Loriga FM, 2006, J THROMB THROMBOLYS, V21, P185, DOI 10.1007/s11239-006-4969-y
  10. Vahanian A, 2012, EUR HEART J, V33, P2451, DOI 10.1093/eurheartj/ehs109
  11. Huang G, 2013, J AM COLL CARDIOL, V62, P1731, DOI 10.1016/j.jacc.2013.07.075
  12. Casais P, 2013, CIRCULATION, V128, P481, DOI 10.1161/CIRCULATIONAHA.113.004259
  13. Elkayam U, 2005, J AM COLL CARDIOL, V46, P403, DOI 10.1016/j.jacc.2005.02.087
  14. Ozkan M, 2013, CIRCULATION, V128, P532, DOI 10.1161/CIRCULATIONAHA.113.001145
  15. Avila Walkiria Samuel, 2005, Arq Bras Cardiol, V84, P44, DOI 10.1590/S0066-782X2005000100010
  16. Bonou Maria, 2012, Eur Heart J Acute Cardiovasc Care, V1, P122, DOI 10.1177/2048872612451169
  17. Katz Marcelo, 2005, Arq Bras Cardiol, V85, P76, DOI 10.1590/S0066-782X2005001400016
  18. McLintock C, 2009, BJOG-INT J OBSTET GY, V116, P1585, DOI 10.1111/j.1471-0528.2009.02299.x
  19. Nishimura Rick A, 2014, J Am Coll Cardiol, V63, pe57, DOI 10.1016/j.jacc.2014.02.536
  20. Parro Adelino Jr, 2004, Arq Bras Cardiol, V82, P346, DOI 10.1590/S0066-782X2004000400006
  21. Sociedade Brasileira de Cardiologia, 2009, ARQ BRAS CARDIOL S1, V93, pe110
  22. Tarasoutchi Flávio, 2011, Arq Bras Cardiol, V97, P1, DOI 10.1590/S0066-782X2011002000001
  23. van Hagen Iris M, 2015, Circulation, V132, P132, DOI 10.1161/CIRCULATIONAHA.115.015242
  24. Whitlock RP, 2012, CHEST, V141, P576, DOI 10.1378/CHEST.11-2305

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - ODS/03