Maternal and fetal sequelae of anticoagulation during pregnancy

Hall, Judith G.; Pauli, Richard M.; Wilson, Kathleen

doi:10.1016/0002-9343(80)90181-3

Cited by 944 publications

(443 citation statements)

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“…Hence, vitamin K is an important regulator of bone and cartilage mineralization. Vitamin K also regulates growth plate cartilage calcification, as revealed by effects of vitamin K antagonism by warfarin (6)(7)(8)(9)(10). Genetic deficiencies of MGP in humans and mice have been linked to skeletal abnormalities, including premature epiphyseal calcification and shortening of long limb bones, reflecting endochondral bone formation (11)(12)(13)(14).…”

mentioning

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Low vitamin K status is associated with osteoarthritis in the hand and knee

Neogi

Booth

Zhang

et al. 2006

Arthritis & Rheumatism

146

101

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Objective. Poor intake of vitamin K is common. Insufficient vitamin K can result in abnormal cartilage and bone mineralization. Furthermore, osteophyte growth, seen in osteoarthritis (OA), may be a vitamin K-dependent process. We undertook this study to determine whether vitamin K deficiency is associated with radiographic features of OA.Methods. We conducted an analysis among 672 participants (mean age 65.6 years, 358 women) in the Framingham Offspring Study, a population-based prospective observational cohort. Levels of plasma phylloquinone (the primary form of vitamin K) had previously been measured in these participants, for whom we also had bilateral hand and knee radiographs. The main outcomes were 1) prevalence ratios (PRs) of OA, osteophytes, and joint space narrowing (JSN) per quartile of plasma phylloquinone level for each joint, adjusting for correlated joints using generalized estimating equations, and 2) adjusted mean number of joints with each feature per quartile of plasma phylloquinone level. Analyses were conducted in hands and knees separately and adjusted for age, sex, body mass index, total energy intake, plasma vitamin D, and femoral neck bone mineral density.Results. The PRs for OA, osteophytes, and JSN and adjusted mean number of joints with all 3 features in the hand decreased significantly with increasing plasma phylloquinone levels (P < 0.03 for all). For example, as plasma phylloquinone levels rose, the PR for hand OA decreased from 1.0 to 0.7 (P ‫؍‬ 0.005). For the knee, only the PR for osteophytes and the adjusted mean number of knee joints with osteophytes decreased significantly with increasing plasma phylloquinone levels (PR decreased from 1.0 to 0.6, P ‫؍‬ 0.01).Conclusion. These observational data support the hypothesis of an association between low plasma levels of vitamin K and increased prevalence of OA manifestations in the hand and knee.

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confidence: 99%

Low vitamin K status is associated with osteoarthritis in the hand and knee

Neogi

Booth

Zhang

et al. 2006

Arthritis & Rheumatism

146

101

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“…Circulating levels of vita min K in osteoporotic patients have been shown to be significantly lower than those in age-matched control subjects (2). The use of a coumarin-related vitamin K an tagonist during pregnancy was found to cause character istic nasal hypoplasia or stippled epiphysis (3). A vitamin K2 homologue, menatetrenone (MK-4), was shown to be effective in ameliorating bone loss induced by ovari ectomy in rats (4), and the clinical efficacy of MK-4 was demonstrated in a double-blind multi-center comparative study with alfacalcidol in patients with postmenopausal and senile osteoporosis (5).…”

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Effects of Menatetrenone on the Decrease in Calcium Balance Induced by Vitamin K-Deficient Diet and Sodium Loading in Rats.

et al. 1994

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ABSTRACT-The effects of menatetrenone (2-methyl-3-tetraprenyl-1,4-naphthoquinone, MK-4) on cal cium balance were studied in male Sprague-Dawley rats. Experiment 1: Rats in metabolic cages that were fed a vitamin K-deficient diet and injected daily with latamoxef (100 mg/kg, i.p.) were either treated or untreated with MK-4 for 7 days. Daily food intake, urine volume and feces weight were determined, and calcium concentration in these samples was measured. Calcium balance was calculated as the difference between calcium intake and urinary and fecal calcium excretion. Cumulative calcium balance in the vitamin K-deficient group treated with latamoxef was lower than that in normal rats; this balance was significantly improved by MK-4 (1 and 10 mg/kg, s.c.) administered for 7 days. Experiment 2: Rats were fed a vitamin K-deficient diet containing 4.6°1o sodium chloride for 6 weeks. MK-4 was administered as a dietary supple ment. Forty-eight-hour calcium balance, determined once a week, was significantly reduced compared with that of normal rats after 3 and 5 weeks; the balance was restored dose-dependently by MK-4 administration (1 and 10 mg/kg). Experiment 3: Rats were subjected to the same experimental conditions as experiment 2 for 6 weeks, and intestinal calcium transport was determined using an everted gut-sac technique. Calcium transport was reduced by the high sodium, vitamin K-deficient diet, and this reduction was restored by MK 4 administration (10 mg/kg). These results suggest that MK-4 improves the reduced calcium balance by increasing intestinal calcium absorption in these rats.

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“…[6][7][8][9] There are no reliable data about the incidence of warfarin embryopathy (5 to 67%), but the risk is diminished when a maximum of 5 mg warfarin is given daily. [5][6][7][8]10 In contrast to warfarin, both unfractionated and low-molecular-weight heparin (LMWH) do not cross the placenta, because of the larger molecular structure 11 and as a consequence decrease the risk of embryopathy. 5 However, the use of LMWH in prosthetic valve patients is not approved, because a recent survey was ended after a high incidence of PHV thrombosis.…”

Section: A B a Bmentioning

confidence: 99%

“…Recent recommendations advocate substituting warfarin after 35 weeks, because of the risk for intracranial haemorrhage of the child during delivery. 8,14 If there is no major bleeding after delivery, unfractionated heparin needs to be restarted four to six hours after delivery and oral anticoagulation can be given after 24 hours (target INR 2.5 to 3.5 in high-risk patients and 2.0 to 3.0 in low-risk patients.…”

Section: A B a Bmentioning

confidence: 99%

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

Kuilenburg¹,

Verheugt²,

Dijk³

2007

NHJL

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In pregnant patients with a prosthetic heart valve (PHV), anticoagulation with warfarin is associated with embryopathy, foetal loss early in pregnancy and maternal bleeding complications in the delivery period. The optimal anticoagulation strategy in the pre-pregnancy period and during pregnancy itself is controversial and a matter of debate. We describe a patient with PHV in the pre-pregnancy period and in a subsequent pregnancy. The optimal anticoagulation treatment strategy in women in their reproductive years with mechanical valve thrombosis is discussed. (Neth Heart J 2007;15: 306-9).

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Maternal and fetal sequelae of anticoagulation during pregnancy

Cited by 944 publications

References 96 publications

Low vitamin K status is associated with osteoarthritis in the hand and knee

Low vitamin K status is associated with osteoarthritis in the hand and knee

Effects of Menatetrenone on the Decrease in Calcium Balance Induced by Vitamin K-Deficient Diet and Sodium Loading in Rats.

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

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