Meta-analyses of Pregnancy Outcomes in Women with Mechanical Heart Valves Treated by Different Anticoagulant Regimens_Chinese Journal of Evidence-Based Medicine

Authors：

LI Tao ¹ , LAI Yi ² , BIAN Ce ¹ ,  LIU Xinghui ¹

1. Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu 610041l, China2. Department of Laboratory Medicine, West China Second Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIU Xinghui, Email: Xinghuiliu@163.com

Keywords：

Anticoagulant regimens; Warfarin; Heparin; Pregnancy; Mechanical heart valves; Meta-analysis

DOI：

10.7507/1672-2531.20080010

Video：

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Objective　 To assess different anticoagulant regimens in pregnant women with mechanical heart valves: taking oral warfarin throughout the pregnancy, or heparin in the 1st trimester and oral warfarin for the other trimesters. The main outcome measures were major maternal complications and perinatal outcomes.
Methods　 The MEDLINE, EMbase, CBM and CNKI were searched. The quality of the included studies was evaluated and data were extracted by two reviewers independently. Meta-analyses were performed on the results of homogeneous studies.
Result　 Seven studies involving 629 pregnancies in 469 patients met the inclusion criteria for this review, all of which were retrospective surveys. The comparison between the administration of heparin in the 1st trimester plus oral warfarin for the other trimesters and warfarin throughout the pregnancy showed that, there are not significant different in the incidence of major maternal complications and the incidence of adverse perinatal outcomes.
Conclusion　 Compared with the administration of warfarin throughout the pregnancy, the administration of heparin in the 1st trimester and oral warfarin for the other trimesters might increase the incidence of major maternal complications, but with a similar incidence of adverse perinatal outcomes.

Citation： LI Tao,LAI Yi,BIAN Ce,LIU Xinghui. Meta-analyses of Pregnancy Outcomes in Women with Mechanical Heart Valves Treated by Different Anticoagulant Regimens. Chinese Journal of Evidence-Based Medicine, 2008, 08(1): 42-48. doi: 10.7507/1672-2531.20080010 Copy

1.	North RA, Sadler L, Stewart AW, et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation, 1999, 99: 2669-2676.
2.	Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects, 1965, 12: 133-140.
3.	Ginsberg JS, Hirsh J. Use of antithrombotic agents duringpregnancy. Chest, 1998, 114(5 uppl): 524S-30S.
4.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA, 2000, 283(15): 2008-2012.
5.	Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare, 2004, 10(6): 318-324.
6.	Adil AM, Lawati Al, Venkitraman M, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. European Journal of Cardio-thoracic Surgery, 2002, 22: 223-227.
7.	Anwar HN, Hobeika EM. Pregnancy outcome in women with prosthetic heart valves. American Journal of Obstetrics and Gynecology, 2004, 191: 1009-1013.
8.	Muhammad A, Amitabh S, et al. Anticoagulation in patienta with mechanical valves during pregnancy. Asian Cardiovasc Throrac Ann, 2005, 13: 30-33.
9.	Meschengieser SS, Fondevila CG, Santarelli MT. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart, 1999, 82(1): 23-26.
10.	Ashour ZA, Hesham Abdel Fattah, et al. Outcome of Pregnancy in Women with Mechanical Valves. Tex Heart Inst J, 2000, 27: 240-245.
11.	雪莲, 郭超华, 周文武, 等. 机械心瓣膜置换术后妊娠低强度抗凝治疗的临床观察. 中国医师杂志, 2003, 5(2): 215-216.
12.	Kim KH, Jeong DS, Ahn H. Anticoagulation in pregnant women with a bileaflet mechanical cardiac valve replacement. Heart Surg Forum, 2007, 10(4): 267-270.
13.	ChanWS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
14.	Vitale N, De Feo M, De Santo LS, et al. Anticoagulation for prosthetid heart valves during pregnancy: the importance of warfarin daily dose. Eur J Cardio- thoracic Surg, 2002, 21(3): 656-657.
15.	Vitale N, De Feo M, Cotrufo M, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33: 1637-1641.
16.	Cotrufo M, De Feo M, et al. Risk of Warfarin During Pregnancy With Mechanical Valve Prostheses. Obestet Gynecol, 2002, 99(1): 35-40.
17.	Elkayam U. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol, 1996, 27(18): 1704-1706.
18.	Massel D, Stephen H. Risks and benefits of adding anti - platelet therapy to warfarin among patients with prosthetic heart valves: a meta- analysis. Journal of the American College of Cardiology,? 2001, 37: 569-578.
19.	Salazar E, Izaguirre R, Verdejo J, et al. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol, 1996, 27: 1698-1703.
20.	Jilma B, Kamath S, Lip GY. Antithrombotic therapy in special circumstances. I- pregnancy and cancer. BMJ, 2003, 326: 37-40(4 Jan).
21.	Sanson BJ, Lensing AW, PrisMH, et al. Safety of low - molecular - weightheparin in pregnancy: a systematic review. Thromb Haemost, 1999, 81: 668-672.
22.	Alexander D, Makatsaria, Victoria O, et al. Use of the low - molecular -weight heparin nadroparin during pregnancy. A review. Curr Med ResOpin, 2003, 19(1): 4-12.
23.	Leyh RG, Fischer S, Ruhparwar A, et al. Anticoagrlation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative? European Journal of Cardio-thoracic Surgery, S2002, 21(12): 577-579.
24.	Gin JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest, 2001, 119: 122s-131s.
25.	Blickstein D, Blickstein L. The risk of fetal loss associated with warfarin anticoagulation. Int J Gynaecol Obstet, 2002, 78: 221-225.

1. North RA, Sadler L, Stewart AW, et al. Long-term survival and valve-related complications in young women with cardiac valve replacements. Circulation, 1999, 99: 2669-2676.
2. Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects, 1965, 12: 133-140.
3. Ginsberg JS, Hirsh J. Use of antithrombotic agents duringpregnancy. Chest, 1998, 114(5 uppl): 524S-30S.
4. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA, 2000, 283(15): 2008-2012.
5. Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare, 2004, 10(6): 318-324.
6. Adil AM, Lawati Al, Venkitraman M, et al. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. European Journal of Cardio-thoracic Surgery, 2002, 22: 223-227.
7. Anwar HN, Hobeika EM. Pregnancy outcome in women with prosthetic heart valves. American Journal of Obstetrics and Gynecology, 2004, 191: 1009-1013.
8. Muhammad A, Amitabh S, et al. Anticoagulation in patienta with mechanical valves during pregnancy. Asian Cardiovasc Throrac Ann, 2005, 13: 30-33.
9. Meschengieser SS, Fondevila CG, Santarelli MT. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart, 1999, 82(1): 23-26.
10. Ashour ZA, Hesham Abdel Fattah, et al. Outcome of Pregnancy in Women with Mechanical Valves. Tex Heart Inst J, 2000, 27: 240-245.
11. 雪莲, 郭超华, 周文武, 等. 机械心瓣膜置换术后妊娠低强度抗凝治疗的临床观察. 中国医师杂志, 2003, 5(2): 215-216.
12. Kim KH, Jeong DS, Ahn H. Anticoagulation in pregnant women with a bileaflet mechanical cardiac valve replacement. Heart Surg Forum, 2007, 10(4): 267-270.
13. ChanWS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
14. Vitale N, De Feo M, De Santo LS, et al. Anticoagulation for prosthetid heart valves during pregnancy: the importance of warfarin daily dose. Eur J Cardio- thoracic Surg, 2002, 21(3): 656-657.
15. Vitale N, De Feo M, Cotrufo M, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33: 1637-1641.
16. Cotrufo M, De Feo M, et al. Risk of Warfarin During Pregnancy With Mechanical Valve Prostheses. Obestet Gynecol, 2002, 99(1): 35-40.
17. Elkayam U. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol, 1996, 27(18): 1704-1706.
18. Massel D, Stephen H. Risks and benefits of adding anti - platelet therapy to warfarin among patients with prosthetic heart valves: a meta- analysis. Journal of the American College of Cardiology,? 2001, 37: 569-578.
19. Salazar E, Izaguirre R, Verdejo J, et al. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol, 1996, 27: 1698-1703.
20. Jilma B, Kamath S, Lip GY. Antithrombotic therapy in special circumstances. I- pregnancy and cancer. BMJ, 2003, 326: 37-40(4 Jan).
21. Sanson BJ, Lensing AW, PrisMH, et al. Safety of low - molecular - weightheparin in pregnancy: a systematic review. Thromb Haemost, 1999, 81: 668-672.
22. Alexander D, Makatsaria, Victoria O, et al. Use of the low - molecular -weight heparin nadroparin during pregnancy. A review. Curr Med ResOpin, 2003, 19(1): 4-12.
23. Leyh RG, Fischer S, Ruhparwar A, et al. Anticoagrlation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative? European Journal of Cardio-thoracic Surgery, S2002, 21(12): 577-579.
24. Gin JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest, 2001, 119: 122s-131s.
25. Blickstein D, Blickstein L. The risk of fetal loss associated with warfarin anticoagulation. Int J Gynaecol Obstet, 2002, 78: 221-225.

Chinese Journal of Evidence-Based Medicine

Meta-analyses of Pregnancy Outcomes in Women with Mechanical Heart Valves Treated by Different Anticoagulant Regimens

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