Anticoagulation for intra-cardiac thrombi in peripartum cardiomyopathy: A review of the literature

Agrawal, Akanksha; Jain, Deepanshu; Ram, Pradhum; Leon, Jorge Luis Penalver; Rangaswami, Janani

doi:10.31083/j.rcm.2019.02.55

Cited by 7 publications

(7 citation statements)

References 29 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, regular assessments of LVEF should be conducted over a period of 6 to 12 months ( 41 ). Although a full recovery is usually achieved within 2 to 6 months from diagnosis, a potential delay up to 5 years has been reported ( 50 ). A cohort study of 36 patients with PPCM [100% with ejection fraction (EF) <45% and 75% with EF <35%] not on prophylactic anticoagulation, showed that, during the 2-year follow-up period, 5 (14%) thromboembolic complications occurred and 2 patients with stroke died.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, bromocriptine, a dopamine agonist that inhibits the release of prolactin, has demonstrated a high rate of full LV recovery in PPCM ( 50 ). Although some case reports suggested that bromocriptine is associated with thromboembolic complications, two prospective cohort studies in ESC and non-ESC countries reported no difference in thromboembolic events with bromocriptine compared [5 events in 84 patients (6%) on bromocriptine vs. 26 events in 463 patients (6%) not on bromocriptine; P=0.802] ( 2 , 28 ).…”

Section: Resultsmentioning

confidence: 99%

“…There is no consensus on the duration of anticoagulation therapy, with some experts suggesting continuation until clinical and echocardiographic recovery ( 41 ). Factors such as patient compliance, the severity of HF, and other clinical considerations should be taken into account when determining need for anticoagulant treatment ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Thromboembolism in peripartum cardiomyopathy: a systematic review

Radakrishnan,

Dokko,

Pastena

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

Background Women with peripartum cardiomyopathy (PPCM) are at an increased risk of arterial and venous thromboembolic events. The review summarizes the evidence on the incidence of thromboembolic complications in women with PPCM, diagnostic approaches, related outcomes, and effects of therapies that have been used. Methods English articles were retrieved from Web of Science and PubMed using search terms to capture studies related to PPCM (or postpartum cardiomyopathy) and all combinations of thrombosis- and embolism-related keywords. A total of 347 articles from PubMed and 85 from Web of Science were obtained, and after removing duplicates, 327 articles were screened for original data and classified into four domains: epidemiology, risk factors, diagnosis, and therapy of thromboembolism in PPCM. Ultimately, 30 articles were included. Data were synthesized in summary tables for each domain. Results Studies in the United States and Europe reported varying incidence for thromboembolism in PPCM, up to 14% in 6 months. Risk factors include elevated levels of coagulation factors, decreased protein C and S activity, decreased fibrinolysis, and a low left ventricular ejection fraction (LVEF). Cesarean delivery and post-operative status were correlated with a higher incidence of thromboembolic complications. Diagnosis relied mostly on ultrasonography and magnetic resonance and depended on the suspected location of thrombus. Anticoagulation has been used mostly for PPCM patients with a reduced LVEF, with the duration varying across guidelines and healthcare systems. Unfractionated heparin and low molecular weight heparin (LMWH) were considered safe choices during pregnancy, while warfarin and novel oral anticoagulants (NOACs) were used postpartum. The association of bromocriptine with risk of thromboembolic complications remains debated. Conclusions There are important gaps in our understanding of the epidemiology, risk stratification, and optimal secondary prevention of thromboembolism in PPCM. Larger prospective studies with detailed phenotyping are required.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Thromboembolism in peripartum cardiomyopathy: a systematic review

Radakrishnan,

Dokko,

Pastena

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…A number of PPCM cases presenting with thromboembolism have been reported in the literature. 15 Although most of them are central, pulmonary and peripheral, coronary thromboembolism has been reported in only 4 cases and is one of the most risky and challenging in differential diagnosis among all thromboembolic complications. [8][9][10][11] No clinical studies are available to guide treatment for cases of coronary embolism without underlying coronary disease, but initiation of reperfusion therapy is indicated (standard for myocardial infarction).…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Peripartum Cardiomyopathy Followed Up for Intracardiac Thrombus and Sudden Embolism of Right Coronary Artery: A Case Report and Review of the Literature

Toprak¹,

BİÇER²,

Taşçanov³

et al. 2023

J Clin Obstet Gynecol

View full text Add to dashboard Cite

ABS TRACT Peripartum cardiomyopathy (PPCM) is a rare disease with high mortality in which dilated heart failure occurs in the last month of pregnancy or within 5 months after delivery, without any other etiology or pre-existing heart disease. Sometimes, it may present with intracardiac thrombus and associated life-threatening embolic complications. Here, we will present the management of a 28-year-old patient who was diagnosed with PPCM and intracardiac thrombus immediately after delivery and was followed up in the intensive care unit, in which an inferior myocardial infarction was detected in the electrocardiogram taken for sudden onset chest pain. Although peripheral thromboembolism is occasionally detected in PPCM patients with intracardiac thrombus, coronary embolisms is not common. Presentation with coronary embolism in patients with PPCM has been described in only 4 cases in the literature, but to the best of our knowledge, this is the first case to describe embolism to the right coronary artery.

show abstract

“…3 TEs have been observed in 5-9% of women with PPCM, 3,6 and an LV thrombus has been revealed in up to 10-15% of cases. 7 In 2011, more than 100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were invited to contribute to the generation of a global PPCM registry under the auspices of the ESC EURObservational Research Programme (EORP). 8 This registry aims to describe disease presentation, comorbidities, diagnosis, and therapeutic management of women with PPCM.…”

mentioning

confidence: 99%