When a Peripartum Cardiomyopathy Patient Hides Various and Serious Risk Factors for Recurrent and Fatal Thromboembolic Events Even Under Well-Conducted Oral Anticoagulation

Toutai, Chaimae; Kallel, Oussama; Laachach, Houssam; Ismaili, Nabila; Elouafi, Noha

doi:10.7759/cureus.12392

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…Increased levels of factor VII, VIII, X, fibrinogen, and von Willebrand; decreased protein C and S activity; and decreased fibrinolysis render PPCM patients more susceptible to thromboembolic events ( 27 , 31 , 36 ).…”

Section: Resultsmentioning

confidence: 99%

“…Several risk factors have been associated with thromboembolic complications in PPCM patients. Hormonal changes during pregnancy contribute to a hypercoagulable state, which can persist for several weeks after delivery, rendering these patients more susceptible to thromboembolic events ( 27 , 36 ). LV systolic dysfunction, which characterizes PPCM, further contributes to blood stasis and the formation of intracardiac thrombi and subsequent systemic embolism, potentially leading to cerebrovascular events and other arterial embolic events, and venous thromboembolic events and PE.…”

Section: Discussionmentioning

confidence: 99%

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Thromboembolism in peripartum cardiomyopathy: a systematic review

Radakrishnan,

Dokko,

Pastena

et al. 2024

J Thorac Dis

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thromboembolism in peripartum cardiomyopathy: a systematic review

Radakrishnan,

Dokko,

Pastena

et al. 2024

J Thorac Dis

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The triglyceride-to-high-density lipoprotein cholesterol ratio is associated with an increased risk of peripartum cardiomyopathy

Chen,

Xiao,

Luo

et al. 2024

Front. Endocrinol.

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BackgroundPeripartum cardiomyopathy (PPCM) is a form of heart failure that severely affects women during the late stages of pregnancy and in the postpartum period. Currently, the diagnosis of PPCM is not fully understood and is likely multifactorial. Abnormal lipid metabolism plays an important role in the onset of cardiovascular diseases, especially in patients with heart failure. Moreover, animal experiments have confirmed a possible association between abnormal lipid metabolism and PPCM onset. However, clinical evidence is currently lacking, and reliable and effective indicators for predicting the onset of PPCM are insufficient. The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) is a novel metabolic marker that is associated with the risk of coronary heart disease. However, the relationship between the TG/HDL-C ratio and the risk of PPCM in parturients remains unknown. Therefore, this study aimed to explore the role of the TG/HDL-C ratio in predicting the risk of PPCM.MethodsThis study included 600 parturients hospitalized at Qilu Hospital of Shandong University between January 2010 and August 2023 (150 patients with PPCM and 450 healthy parturients). The TG/HDL-C ratio was calculated as triglyceride levels (mmol/L)/high-density lipoprotein cholesterol levels (mmol/L). The relationship between the TG/HDL-C ratio and PPCM was analyzed using logistic regression analysis and receiver operating characteristic curve analysis.ResultsSignificant differences were observed in the TG/HDL-C ratio between patients with PPCM and healthy parturients. The TG/HDL-C ratio was higher in patients with PPCM than in healthy parturients (p < 0.001). Logistic regression analysis revealed that the TG/HDL-C ratio increased the risk of PPCM and had predictive accuracy for the onset of PPCM (odds ratio, 1.249; 95% confidence interval, 1.004–1.553; p = 0.046). Moreover, the TG/HDL-C ratio was positively correlated with the NT-proBNP levels at the onset of PPCM (R2 = 0.081, p = 0.008).ConclusionsA higher TG/HDL-C ratio was significantly associated with the risk of PPCM.

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When a Peripartum Cardiomyopathy Patient Hides Various and Serious Risk Factors for Recurrent and Fatal Thromboembolic Events Even Under Well-Conducted Oral Anticoagulation

Cited by 2 publications

References 21 publications

Thromboembolism in peripartum cardiomyopathy: a systematic review

Thromboembolism in peripartum cardiomyopathy: a systematic review

The triglyceride-to-high-density lipoprotein cholesterol ratio is associated with an increased risk of peripartum cardiomyopathy

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