Curriculum in Cardiology The clinical challenge of bridging anticoagulation with low-molecular-weight heparin in patients with mechanical prosthetic heart valves: An evidence-based comparative review focusing on anticoagulation options in pregnant and nonpregnant patients
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چکیده
The clinical challenge of bridging anticoagulation with low-molecular-weight heparin in patients with mechanical prosthetic heart valves: An evidence-based comparative review focusing on anticoagulation options in pregnant and nonpregnant patients Niranjan Seshadri, MD, Samuel Z. Goldhaber, MD, FACC, Uri Elkayam, MD, FACC, Richard A. Grimm, DO, FACC, James B. Groce III, PharmD, John A. Heit, MD, FACC, Sarah A. Spinler, PharmD, FCCP, Alexander G. G. Turpie, MD, FRCP, FRCP(C), FACC, Gideon Bosker, MD, and Allan L. Klein, MD, FRCP(C), FACC Cleveland, Ohio, Boston, Mass, Los Angeles, Calif, Chapel Hill, NC, Rochester, Minn, Philadelphia, Pa, Hamilton, Ontario, Canada, and New Haven, Conn
منابع مشابه
Anticoagulation in pregnant women with prosthetic heart valves.
The combination of heart disease and pregnancy can present a formidable challenge to the clinician entrusted to care for both the mother and fetus. Since most data is retrospective, a definitive prognosis for such a patient may be difficult to obtain. Nevertheless, certain cardiac conditions carry greater risks of maternal mortality than do others. However, even for certain preexisting conditio...
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• The group of patients where this issue is of prime importance is when considering those groups of patients with underlying Atrial Fibrillation (AF) and prosthetic heart valves. The risk of embolisation is increased with mitral valve prostheses, caged ball devices and multiple prosthetic valves. • It is equally of paramount importance to calculate the thromboembolic risk by applying the CHADS2...
متن کاملAnticoagulation of pregnant women with mechanical heart valves using low-molecular-weight heparin.
The management of pregnant women with mechanical heart valves is challenging. Recently, based on small numbers of patients and poor-quality data, correspondence from Aventis Pharmaceuticals Inc has described treatment "failures" and concerns about teratogenicity with the use of the low-molecular-weight heparin (LMWH) enoxaparin. The company issued a "Warning" that enoxaparin should not be used ...
متن کاملAnticoagulation of Pregnant Women With Mechanical Heart Valves
T he management of pregnant women with mechanical heart valves is challenging. Recently, based on small numbers of patients and poor-quality data, correspondence from Aventis Pharmaceuticals Inc has described treatment “failures” and concerns about teratogenicity with the use of the low-molecular-weight heparin (LMWH) enoxaparin. The company issued a “Warning” that enoxaparin should not be used...
متن کاملOutcomes and total costs of outpatient vs. inpatient peri-procedural anticoagulation management of mechanical prosthetic heart valve patients.
BACKGROUND/OBJECTIVES The most cost-effective periprocedural management of patients with mechanical heart valves (MHV) is uncertain. The objective was to compare the effectiveness, safety and costs for inpatient intravenous unfractionated heparin (IVUH) vs. outpatient low molecular weight heparin (LMWH) "bridging" as periprocedural anticoagulation management for MHV patients. METHODS In a cas...
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