Low-dose warfarin maternal anticoagulation and fetal warfarin syndrome

Barreira, Rita; Santos, Edmundo

doi:10.1136/bcr-2017-223159

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…The child in the present case was exposed to warfarin during the first trimester and was diagnosed with warfarin embryopathy in the form of hypoplastic nasal bone/stippling of cartilage in the femur and calceneum. These congenital anomalies have been common findings in children born to mothers with warfarin intake during the first trimester 15–17. The appearance of the nose is often flattened and upturned and has been attributed to the nasal hypoplasia and depression of the bridge of the nose.…”

Section: Discussionmentioning

confidence: 99%

Dentofacial manifestations of fetal warfarin syndrome in a paediatric patient

et al. 2022

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Anticoagulant therapy is commonly indicated during pregnancy to prevent thrombosis and prevention of prosthetic heart valve-associated thromboembolic events. Warfarin is a synthetic anticoagulant with low molecular weight and can cross the placenta resulting in congenital abnormalities termed fetal warfarin syndrome. This paper highlights the case of an 8-year-old boy with warfarin embryopathy. It highlights the extraoral and intraoral findings of the case along with the cephalometric analysis and provides insight into the phenotypic variations among the different cases reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Dentofacial manifestations of fetal warfarin syndrome in a paediatric patient

et al. 2022

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“…Although warfarin is the safest anticoagulant for the mother when used during pregnancy, it does have the potential to cause fetal disease [19]. However, the true incidence of fetal embryopathy when warfarin is administered remains controversial and appears to depend on the dose and duration of pregnancy exposure [20].…”

Section: Discussionmentioning

confidence: 99%

The ultrasound outcomes of a pregnant female undergoing a double anticoagulant regimen due to suspected mechanical valve thrombosis: a case report and a literature review

Bai

Wenying

et al. 2022

Preprint

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Most previous treatment guidelines for pregnant women with mechanical heart valves (MHVs) recommended that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of around 1.0–1.2 IU/mL,but it is commonly associated with and subtherapeutic trough levels consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6-0.7 IU/mL and with peak anti-Xa levels of around 1.0–1.2 IU/mL or less than 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy.In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy.

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“…5,9,10 The absolute contraindications of warfarin use are pregnancy for fear of Fetal warfarin syndrome causing fetal malformations and an increased risk of spontaneous abortion and stillbirths. 11 The INR need to be repeated within 1 to 7 days in all patients on anticoagulants to ensure it within the therapeutic range of 2.0 to 3.0 and at least 2 to 4 weekly during the maintenance phase. INR should also be checked at starting, discontinuing and changing doses of drugs that are known to interact with warfarin.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report

et al. 2019

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Spontaneous iliopsoas hematoma is a rare complication in patients suffering from bleeding disorders like hemophilia, Von Willebrand’s disease or those taking blood thinners like aspirin and clopidogrel or anticoagulant medications like warfarin for atrial fibrillation or post-thrombotic status. It can present as severe pain, muscle dysfunction, difficult walking or neurological dysfunction due to compression on femoral nerve or lumbar plexus. A high index of suspicion with early blood and radiological investigations like contrast enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) of the part is immensely helpful in diagnosis and prompt management of such patients. A low hemoglobin or hematocrit level and a high INR is supportive while CECT or MRI of the abdomen and pelvis is confirmatory. Management in a hemodynamically and neurologically stable patient include immediate withdrawl of the anticoagulant, bed rest, infusion of I.V. fluids, vitamin K, fresh frozen plasma and packed red cell transfusion, which ensures complete recovery in most of the cases. However angio-embolization to control ongoing arterial bleeding is lifesaving when feasible or emergent open decompression and bleeding control surgery can save the life or prevent permanent neurological damage to the limb. Decompression of the hematoma by ultrasound or computed tomography guided catheter drainage is helpful alternative in few selected cases. We report an elderly patient on warfarin, who suddenly developed difficulty in walking within hours of a strained defecation, diagnosed to suffer from left iliopsoas hematoma and responded to conservative management with complete resolution of symptoms by 3 weeks.

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Low-dose warfarin maternal anticoagulation and fetal warfarin syndrome

Cited by 14 publications

References 19 publications

Dentofacial manifestations of fetal warfarin syndrome in a paediatric patient

Dentofacial manifestations of fetal warfarin syndrome in a paediatric patient

The ultrasound outcomes of a pregnant female undergoing a double anticoagulant regimen due to suspected mechanical valve thrombosis: a case report and a literature review

Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report

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