Lily Aboud, Helen Tanner, William Parsonage, Karin Lust, Leonie Callaway
{"title":"因分娩而中断抗凝治疗的机械心脏瓣膜孕妇的出血和血栓栓塞结局--病例系列。","authors":"Lily Aboud, Helen Tanner, William Parsonage, Karin Lust, Leonie Callaway","doi":"10.1111/ajo.13897","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.</p><p><strong>Aims: </strong>Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.</p><p><strong>Materials and methods: </strong>Design: case series, single centre.</p><p><strong>Setting: </strong>Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022.</p><p><strong>Population: </strong>all pregnant women with mechanical heart valves (any type) who birthed.</p><p><strong>Main outcome measures: </strong>intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.</p><p><strong>Results: </strong>There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.</p><p><strong>Conclusions: </strong>Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Haemorrhagic and thromboembolic outcomes in pregnant patients with mechanical heart valves who undergo interruption of anticoagulation for birth - A case series.\",\"authors\":\"Lily Aboud, Helen Tanner, William Parsonage, Karin Lust, Leonie Callaway\",\"doi\":\"10.1111/ajo.13897\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.</p><p><strong>Aims: </strong>Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.</p><p><strong>Materials and methods: </strong>Design: case series, single centre.</p><p><strong>Setting: </strong>Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022.</p><p><strong>Population: </strong>all pregnant women with mechanical heart valves (any type) who birthed.</p><p><strong>Main outcome measures: </strong>intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.</p><p><strong>Results: </strong>There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.</p><p><strong>Conclusions: </strong>Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.</p>\",\"PeriodicalId\":55429,\"journal\":{\"name\":\"Australian & New Zealand Journal of Obstetrics & Gynaecology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Australian & New Zealand Journal of Obstetrics & Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ajo.13897\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian & New Zealand Journal of Obstetrics & Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ajo.13897","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Haemorrhagic and thromboembolic outcomes in pregnant patients with mechanical heart valves who undergo interruption of anticoagulation for birth - A case series.
Background: Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.
Aims: Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.
Materials and methods: Design: case series, single centre.
Setting: Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022.
Population: all pregnant women with mechanical heart valves (any type) who birthed.
Main outcome measures: intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.
Results: There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.
Conclusions: Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence-based guidelines for postpartum anticoagulation management.
期刊介绍:
The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.