Anticoagulation In Pregnancy Research Articles

Acute Coagulopathy in Pregnancy

Pregnancy alters both the fibrinolytic system and coagulation cascade. In addition, pregnancy presents unique triggering mechanisms for DIC. Management of DIC in pregnancy should include removal of the triggering mechanism, blood, and factor replacement. Inherited coagulation defects, while rarely resulting in bleeding diathesis in the pregnant patient, do require monitoring of maternal factor levels. Genetic counseling should be offered to all patients with inheritable coagulation disorders.

Optimum use of anticoagulants in pregnancy.

Pregnant women pose special problems when deciding upon optimal anticoagulant therapy. Heparin does not cross the placenta and is probably safe for the fetus. Long term heparin therapy is occasionally associated with maternal haemorrhage and rarely with symptomatic osteoporosis. Coumarin derivatives, however, cross the placenta and are potentially teratogenic, particularly in the first trimester. Neonatal infant haemorrhage is a possibility if warfarin is administered to the pregnant mother near term. For the prevention and treatment of venous thromboembolism, heparin is the anticoagulant of choice since its safety and efficacy are well established. For the prevention of systemic embolism associated with prosthetic heart valves or valvular heart disease, the efficacy of heparin has not been established. Nevertheless, 12-hourly subcutaneous heparin in doses to prolong a mid-interval activated partial thromboplastin time (aPTT) to 1.5 times control is likely to be effective and safe. An alternative is to use heparin for the first trimester, change to warfarin until the middle of the third trimester, then to restart heparin until term. However, before warfarin is used in pregnant patients, the risks should be carefully explained to the patient to help avoid medicolegal problems. Warfarin can be safely used postpartum by the breast-feeding mother.

Effects of castration, exogenous testosterone and estrogen on endotoxin response in male rats

Using an experimental model of continuous endotoxin infusion, the effects of castration, testosterone and estrogen substitution on disseminated intravascular coagulation in male rats were investigated. Male rats which are not pretreated react in the same way to an endotoxin infusion as female animals, with an increase in free plasma hemoglobin, decrease of fibrinogen level, decrease of hematocrit and platelets and glomerular fibrin depositions. Different experimental groups of testectomized rats were pretreated with (i) 0.3 μg (pregnancy-conserving dose) or (ii) 30 μg ethinylestradiol (ovulation-suppression dose) or (iii) 250 mg testosterone. They were then compared to groups of animals treated with sesame oil as well as untreated group of rats. The pretreatment with testosterone and estrogens in the small-dose group had only an insignificant effect on the shock sequence. Only those animals which were treated with a high dose of estrogens showed a dramatic enhancement of their endotoxin sensitivity. It was also shown that in male animals an increased estrogen level might mediate a state of ‘preparation’, but testosterone does not ‘prepare’ castrated rats for the generalized Schwartzman reaction. The possible significance of enhancement of endotoxin toxicity by estrogens in explaining some pathophysiological characteristics of disseminated intravascular coagulation in pregnancy is discussed.

Prescribing in Pregnancy

Contributors. Preface. 1 Identifying fetal abnormalities: Lena M. Macara (The Queen Mother's Hospital). 2 Treatment of common, minor and self-limiting conditions: Anthony J. Avery (Nottingham University Hospitals, Queen's Medical Centre Campus), Susan L. Brent(Regional Drug and Therapeutics. Centre, Wolfson Unit, Newcastle upon Tyne). 3 Antibiotics in pregnancy: Tim Weller (City Hospital, Birmingham), Conor Jamieson (Heart of England NHS Foundation Trust, Birmingham). 4 Anticoagulants in pregnancy: Bethan Myers (Nottingham University Hospitals, Queen's Medical Centre Campus). 5 Treatment of cardiovascular diseases: Asma Khalil (Homerton University Hospital), Pat O'Brien (University College London Hospitals). 6 Treatment of endocrine diseases: Anastasios Gazis (Nottingham University Hospitals, Queen's Medical Centre Campus). 7 Drugs in rheumatic disease during pregnancy: Mary Gayed (City Hospital, Sandwell and West Birmingham Hospitals NHS Trust), Caroline Gordon (Medical School, University of Birmingham). 8 Psychotropic drugs in pregnancy: Neelam Sisodia (Nottingham University Hospitals, Queen's Medical Centre Campus). 9 Managing epilepsy and anti-epileptic drugs during pregnancy: Michael F. O'Donoghue (Nottingham University Hospitals, Queen's Medical Centre Campus), Christine P. Hayes (Nottingham University Hospitals, Queen's Medical Centre Campus). 10 Treatment of diabetes in pregnancy: Nick Vaughan (Royal Sussex County Hospital), Kate Morel (Brighton and Sussex University Hospitals NHS Turst), Louise Walker (Royal Sussex County Hospital). 11 Treatment of asthma: Catherine Williamson (Hammersmith Hospital, Imperial College), Anita Banerjee (Hammersmith Hospital). 12 Drugs of misuse: Mary Hepburn (Princess Royal Maternity, Glasgow). 13 Prescribing for the pregnant traveller: Pauline A. Hurley (John Radcliffe Hospital, Oxford). 14 Drugs in breastfeeding: Jane M. Rutherford (Nottingham University Hospitals, Queen's Medical Centre Campus). Index

Use of anticoagulants in pregnancy

Thromboembolic disease affects between 1 and 3 of every 1000 pregnant women.1 It is the second commonest cause of maternal death after hypertensive disease. Prevention and treatment with anticoagulants poses special problems because of the increase in coagulability and decrease in fibrinolysis during pregnancy and because of the increased risks to mother and fetus.2 Optimal procedures are far from agreed but the management of individual patients will be improved if obstetrician, general practitioner and haematologist work together to an agreed treatment plan. This article discusses how best to use anticoagulants in the management of thromboembolic disease in pregnancy.

2) Circulating Anticoagulants in Pregnancy and Parturition

2) Circulating Anticoagulants in Pregnancy and Parturition

What are the risks of anticoagulants in pregnancy?

What are the risks of anticoagulants in pregnancy?

Intravascular coagulation in obstetrics: Serial dilution protamine sulfate test throughout labor

Serial dilution protamine sulfate tests (SDPS) were performed in 191 women during labor. It was found that 27 per cent of women with uncomplicated pregnancies and 42 per cent with complicated pregnancies had positive SDPS tests, the highest incidence being between three and six hours of labor. These findings support the previous report of a physiologic disseminated intravascular coagulation in pregnancy but make the SDPS test of little value in obstetric cases.

Letter: Venous thromboembolism and anticoagulants in pregnancy.

Letter: Venous thromboembolism and anticoagulants in pregnancy.

Editorial: Venous thromboembolism and anticoagulants in pregnancy.

Editorial: Venous thromboembolism and anticoagulants in pregnancy.

Disseminated intravascular coagulation in pregnancy.

Disseminated intravascular coagulation in pregnancy.

Fetal Effects of Coumadin Administered During Pregnancy

Abstract The safest and most practical method of administering long-term anticoagulants in pregnancy is uncertain because treatment of the mother with vitamin K antagonists may be complicated by hemorrhage in the fetus. The effects on the fetus of giving coumadin in pregnancy was evaluated in rabbits. When coumadin was given from early pregnancy until term, all of the fetuses were stillborn with widespread hemorrhages. However, the fetuses were born alive and without hemorrhage when (1) coumadin was stopped 4-5 days before delivery, at which time the level of coagulation factors had almost returned to normal and (2) when delivery was performed by cesarean section at a time when the fetal coagulation defect was severe. It is suggested that the risk of fetal hemorrhage is high only when fetuses with a severe coagulation defect are exposed to the trauma of delivery.

Blood coagulation in pregnancy: proconvertin and prothrombin, and the hypercoagulable state.

ALTHOUGH thromboembolism has frequently been attributed to abnormal blood coagulation, convincing evidence for this concept has been lacking. The disclosure of hitherto unrecognized coagulation factors and the development of methods for their assay prompted re-examination of this question. Pregnancy was selected as the initial area of study because it constitutes a common, temporary, reversible, physiologic state that is too frequently complicated by thromboembolism. This report presents data indicating that during pregnancy abnormally high levels of at least one important clotting constituent do develop, returning to normal in most cases after term. It is proposed that these changes reflect a state . . .