Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas

Background: Oral anticoagulation therapy in pregnant women with prosthetic heart valves is associated with a greater risk of abortion, fetal malformations and thromboembolic complications. Aim: To assess the use of subcutaneous heparin in women with pregnancies of less than 12 weeks as an alternativ...

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Autores principales:	Parra R,Claudio, Kauffmann Q,Ronald, Chateau,Bernardita, Cabrera A,Elsa
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 1999
Materias:	Anticoagulants Coumarinics Heparin Pregnancy complications, medical
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98871999001200009
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spelling	oai:scielo:S0034-988719990012000092000-04-05Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacasParra R,ClaudioKauffmann Q,RonaldChateau,BernarditaCabrera A,Elsa Anticoagulants Coumarinics Heparin Pregnancy complications, medical Background: Oral anticoagulation therapy in pregnant women with prosthetic heart valves is associated with a greater risk of abortion, fetal malformations and thromboembolic complications. Aim: To assess the use of subcutaneous heparin in women with pregnancies of less than 12 weeks as an alternative to oral anticoagulation therapy. Material and methods: Pregnant women were admitted to the hospital and coumarinics were replaced with not fractionated subcutaneous heparin in a dose of 10,000 IU every 12 hours, aiming at prolonging partial thromboplastin time, 2 or 2 1/2 times. During the hospitalization period, women were taught about the heparin injection technique. Coumarinics were restarted after week 13 of pregnancy until 10 days prior to the delivery date in which women were again admitted to the hospital and intravenous heparin was used until the delivery. Results: Between 1991 and 1997, this protocol was used during ten pregnancies in seven women aged 19 to 36 years old. Five had a Starr-Edwards prosthesis, one had a mitral Björk-Shilley prosthesis and one, a double prosthesis (mitral Starr-Machi and aortic St Jude). Subcutaneous heparin was started in the fifth week of pregnancy in 1 case, in the sixth week in seven and in the seventh week in two. There was no maternal mortality and one transient ischemic attack without sequelae. One non compliant patient had a Björk Shilley prosthetic valve dysfunction that required a valve replacement at the twelfth week of pregnancy and she had a spontaneous abortion at week 15. Other patient had a pneumonia at week 37 and gave birth to a stillbirth. There were no fetal malformations. Conclusions: This therapeutic protocol can be used among Chilean patients, but must be restricted to compliant women and a strict surveillance must be maintained.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.127 n.12 19991999-12-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98871999001200009es10.4067/S0034-98871999001200009
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Anticoagulants Coumarinics Heparin Pregnancy complications, medical
spellingShingle	Anticoagulants Coumarinics Heparin Pregnancy complications, medical Parra R,Claudio Kauffmann Q,Ronald Chateau,Bernardita Cabrera A,Elsa Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
description	Background: Oral anticoagulation therapy in pregnant women with prosthetic heart valves is associated with a greater risk of abortion, fetal malformations and thromboembolic complications. Aim: To assess the use of subcutaneous heparin in women with pregnancies of less than 12 weeks as an alternative to oral anticoagulation therapy. Material and methods: Pregnant women were admitted to the hospital and coumarinics were replaced with not fractionated subcutaneous heparin in a dose of 10,000 IU every 12 hours, aiming at prolonging partial thromboplastin time, 2 or 2 1/2 times. During the hospitalization period, women were taught about the heparin injection technique. Coumarinics were restarted after week 13 of pregnancy until 10 days prior to the delivery date in which women were again admitted to the hospital and intravenous heparin was used until the delivery. Results: Between 1991 and 1997, this protocol was used during ten pregnancies in seven women aged 19 to 36 years old. Five had a Starr-Edwards prosthesis, one had a mitral Björk-Shilley prosthesis and one, a double prosthesis (mitral Starr-Machi and aortic St Jude). Subcutaneous heparin was started in the fifth week of pregnancy in 1 case, in the sixth week in seven and in the seventh week in two. There was no maternal mortality and one transient ischemic attack without sequelae. One non compliant patient had a Björk Shilley prosthetic valve dysfunction that required a valve replacement at the twelfth week of pregnancy and she had a spontaneous abortion at week 15. Other patient had a pneumonia at week 37 and gave birth to a stillbirth. There were no fetal malformations. Conclusions: This therapeutic protocol can be used among Chilean patients, but must be restricted to compliant women and a strict surveillance must be maintained.
author	Parra R,Claudio Kauffmann Q,Ronald Chateau,Bernardita Cabrera A,Elsa
author_facet	Parra R,Claudio Kauffmann Q,Ronald Chateau,Bernardita Cabrera A,Elsa
author_sort	Parra R,Claudio
title	Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
title_short	Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
title_full	Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
title_fullStr	Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
title_full_unstemmed	Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
title_sort	heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas
publisher	Sociedad Médica de Santiago
publishDate	1999
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98871999001200009
work_keys_str_mv	AT parrarclaudio heparinasubcutaneaduranteelprimertrimestredelembarazoenmujeresconprotesisvalvularesardiacas AT kauffmannqronald heparinasubcutaneaduranteelprimertrimestredelembarazoenmujeresconprotesisvalvularesardiacas AT chateaubernardita heparinasubcutaneaduranteelprimertrimestredelembarazoenmujeresconprotesisvalvularesardiacas AT cabreraaelsa heparinasubcutaneaduranteelprimertrimestredelembarazoenmujeresconprotesisvalvularesardiacas
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Heparina subcutánea durante el primer trimestre del embarazo en mujeres con prótesis valvulares ardíacas

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