warfarin and Puerperal-Disorders

Puerperal ovarian vein thrombophlebitis is a rare pathology. We present the case of a 23-year-old female who presented with fever and cough that occurred after vaginal delivery and persisted after several courses of antibiotics between the 2nd and 20th day postpartum. CT pulmonary angiography revealed right subsegmental pulmonary embolism. An abdominal ultrasonographic examination led to the diagnosis of ovarian vein thrombosis. She was treated with warfarin for 2 weeks with a good response. Our case highlights the importance of prompt ultrasonographic diagnosis and clinical treatment of ovarian vein thrombosis to prevent morbidity and mortality.

Topics: Adult; Computed Tomography Angiography; Delivery, Obstetric; Female; Humans; Ovary; Pregnancy; Puerperal Disorders; Pulmonary Embolism; Thrombophlebitis; Warfarin; Young Adult

For haemostatic and circulatory reasons pregnancy is associated with an about 6-fold relative increase of thrombotic risk which is further raised by additional risk factors, such as history of thrombosis or acquired and hereditary thrombophilia, respectively. Recently, the thrombophilias have been revealed as risk factors for severe preeclampsia, abruptio placentae, fetal growth retardation, abortion and still birth as well. Thus, there are several situations in which the question for the need of antithrombotic medication is raised in a pregnant woman, either for therapy of acute thromboembolism or for prophylaxis of thrombosis and obstetrical complications, respectively. While acute thromboembolism has to be treated in every case, indication for prophylaxis has to be weighed in the light of the individual risk profile of the pregnant woman and the potential side effects and inconvenience of the medication. The first part of this article deals with the pregnancy related problems of coumarins, heparins and aspirin and demonstrates that the low molecular weight heparins are the anticoagulants of choice for most indications in pregnancy. The second part of this overview shows in which specific situations and how the antithrombotic medications mentioned above are used in pregnancy.

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Abruptio Placentae; Administration, Oral; Adult; Anticoagulants; Aspirin; Blood Coagulation Tests; Coumarins; Female; Fetal Death; Fetal Growth Retardation; Fibrinolytic Agents; Heart Valve Prosthesis; Heparin; Heparin, Low-Molecular-Weight; Humans; Infant, Newborn; Platelet Aggregation Inhibitors; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Pulmonary Embolism; Risk Factors; Thrombocytopenia; Thrombophilia; Thrombosis; Warfarin

In general, the current recommendations for treating and prophylaxing thrombotic patients with hereditary defects are similar to those for thrombotic individuals without a defect. Determinations as to the need for long-term anticoagulation require that a clinical assessment be made regarding the relative benefit in preventing thrombotic episodes versus the risk of increased bleeding. With our newly found ability to identify genetic risk factors in a substantial fraction of patients with venous thrombosis and pulmonary embolism, it will be possible to perform rigorously designed studies to determine whether they should be managed with more prolonged or intense anticoagulation after a thrombotic event or more aggressive prophylactic regimens in high risk situations such as a total hip replacement.

Topics: Abnormalities, Drug-Induced; Anticoagulants; Antithrombin III; Antithrombin III Deficiency; Blood Proteins; Coumarins; Disease Susceptibility; Drug Eruptions; Factor V Deficiency; Female; Fibrinolytic Agents; Genetic Predisposition to Disease; Humans; Infant, Newborn; Male; Necrosis; Pregnancy; Pregnancy Complications, Hematologic; Prevalence; Protein C; Protein S Deficiency; Puerperal Disorders; Purpura; Recurrence; Risk; Thrombolytic Therapy; Thrombosis; Warfarin

Deep venous thrombosis and pulmonary embolism are relatively frequent occurrences in pregnancy and the postpartum period. The diagnosis of deep venous thrombosis and pulmonary embolism requires accurate objective tests because clinical diagnosis is unreliable. Procedures that expose the fetus to ionizing radiation must sometimes be performed to make an accurate diagnosis; current evidence suggests that the adverse effects to the fetus associated with such procedures are minimal. Heparin is the anticoagulant of choice during pregnancy and is used for both the treatment and prevention of venous thrombosis and pulmonary embolism. Patients with deficiencies of antithrombin III, protein C, or protein S as well as patients with antiphospholipid antibodies are at increased risk for thrombotic complications and require particular vigilance during pregnancy.

Topics: Acute Disease; Antibodies, Antiphospholipid; Blood Proteins; Female; Heparin; Humans; Incidence; Ovary; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Pulmonary Embolism; Thrombophlebitis; Thrombosis; Warfarin

A 29-yr-old writer presented with seizures and left hemiparesis 8 days post-partum. Studies revealed right parietal hemorrhagic infarction secondary to superior sagittal sinus thrombosis. An anticoagulant was given for clot extension associated with increasing cerebral edema and coma. Inpatient rehabilitation was undertaken for residual left hemiparesis, most severe in the leg. Left arm strength rapidly returned to normal. Significant improvement in left leg strength occurred but was delayed for many months. Intracerebral thrombosis is an uncommon but significant cause of stroke in young adults. It frequently occurs in the puerperium and may be associated with unilateral or bilateral neurologic deficits. Treatment with anticoagulants is controversial because of the risk of hemorrhagic cerebral infarction, but may be beneficial in some cases. Recovery may be delayed for several months pending recanalization of the sinus or the development of collateral circulation. The overall prognosis for neurologic and functional recovery in survivors of intracerebral thrombosis is good.

Topics: Adult; Female; Heparin; Humans; Intracranial Embolism and Thrombosis; Puerperal Disorders; Thrombosis; Vena Cava Filters; Warfarin

Topics: Adult; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Follow-Up Studies; Hematoma; Humans; Ovary; Pregnancy; Pregnancy, Multiple; Puerperal Disorders; Pulmonary Embolism; Rectus Abdominis; Risk Factors; Sepsis; Tinzaparin; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

Postpartum women can develop headache, and their assessment requires a thorough and multidisciplinary approach. If the headache is unresponsive to treatment and accompanied by neurological deficit, neuroimaging needs to be undertaken to rule out other life-threatening causes.

Topics: Adult; Analgesia, Epidural; Anticoagulants; Anticonvulsants; Cerebral Veins; Female; Headache; Heparin; Humans; Postpartum Period; Puerperal Disorders; Sinus Thrombosis, Intracranial; Spinal Puncture; Tomography, X-Ray Computed; Warfarin

Previously reported only a few times before, we present a case of extracranial vertebral dissection and spontaneous frontoparietal subarachnoid hemorrhage (SAH) in the puerperium, discussing possible mechanisms and difficulties in management. A 35-year-old woman presented 10 days postcaesarean section with neck pain and vertigo with normal initial investigations. Following recurrent vertigo, headache, and ataxia, imaging revealed a frontoparietal SAH and vertebral artery dissection. The patient was consequently treated with aspirin, and then following a return of symptoms 3 weeks later, warfarin therapy was continued for 6 months. The possible underlying mechanisms for this case are discussed, including reversible cervical vasoconstriction syndrome and posterior reversible encephalopathy syndrome, although neither was identified. The small SAH alongside recurrent posterior circulation symptoms resulted in the initiation of antithrombotic therapy. This report supports studies demonstrating higher incidence of cervicocephalic arterial dissection in the puerperium. Moreover, the heterogeneous presentation and manifestations of such cases require individualized treatment, and warrant studies into underlying mechanisms behind extracranial dissection and nonaneurysmal SAH.

Topics: Adult; Anticoagulants; Aspirin; Female; Humans; Neck Pain; Puerperal Disorders; Subarachnoid Hemorrhage; Treatment Outcome; Vertebral Artery Dissection; Vertigo; Warfarin

Topics: Adult; Antibodies, Monoclonal, Murine-Derived; Anticoagulants; Cesarean Section; Combined Modality Therapy; Enoxaparin; Female; Hemorrhage; Heparin; Humans; Infant, Newborn; Interdisciplinary Communication; Laryngeal Edema; Methylprednisolone; Patient Care Team; Plasma Exchange; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Pulmonary Embolism; Purpura, Thrombotic Thrombocytopenic; Recurrence; Rituximab; Warfarin

In this report, we describe a patient who developed severe headache following epidural analgesia for labor and delivery. Although the epidural puncture had been reported to be uneventful, headache was initially suspected to result from an accidental dural puncture. After the headache worsened, a sinus venous thrombosis was suspected and subsequently confirmed by magnetic resonance imaging. This case highlights the difficulty of differential diagnosis of headache in the postnatal period in patients after EDA and stresses the necessity of considering alternative pathologies.

Topics: Adult; Analgesia, Epidural; Analgesics; Anticoagulants; Diagnosis, Differential; Female; Fibrinolytic Agents; Heparin; Humans; Magnetic Resonance Imaging; Post-Dural Puncture Headache; Postpartum Period; Pregnancy; Puerperal Disorders; Severity of Illness Index; Treatment Outcome; Venous Thrombosis; Warfarin

A 22-year old woman visited the LAMB Hospital, Parbatipur, Dinajpur, Bangladesh, in February 2010, with exertional dyspnea for three weeks. She had had a normal vaginal delivery four months ago; 2-dimensional echocardiogram showed severe left ventricular dysfunction and biventricular thrombi, which resolved without complications after anticoagulation. Biventricular thrombosis with peripartum cardiomyopathy is quite a rare finding, and its clinical course and proper management is not known. No such case has previously been reported in Bangladesh.

Topics: Bangladesh; Cardiomyopathies; Drug Combinations; Echocardiography; Enalapril; Female; Furosemide; Humans; Peripartum Period; Puerperal Disorders; Thrombosis; Ventricular Dysfunction, Left; Warfarin; Young Adult

Topics: Anticoagulants; Cerebral Veins; Drug Therapy, Combination; Female; Heparin, Low-Molecular-Weight; Humans; Magnetic Resonance Angiography; Papilledema; Postpartum Period; Pregnancy; Puerperal Disorders; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Visual Acuity; Visual Fields; Warfarin; Young Adult

Guidelines concerning the prevention and treatment of pregnancy-associated venous thromboembolism (VTE) have been elaborated by the American College of Chest Physicians and published in Chest in 2008. In this review, they have been compared with European guidelines and discussed taking into account the papers published since 2008.Most recommendations are of low grade of evidence because randomized studies are lacking during pregnancy and many reflect guidelines proposed by experts. The decisions on the most appropriate prophylaxis, dose to be administered and moment of pregnancy for starting prophylaxis are often decided case by case after careful assessment of the risk of pregnancy-associated VTE, on one hand, and the risk for the mother, on the other.Risk factors (age >or= 35, obesity, history of VTE with or without sequellae, in vitro fertilization)or thrombophilia have to be taken into account. Scores have been proposed to improve standardisation and evaluation of the risk of VTE and they should be validated.

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Benzimidazoles; Blood Loss, Surgical; Cesarean Section; Contraindications; Dabigatran; Europe; Evidence-Based Medicine; Female; Fetus; Fondaparinux; Heparin; Heparin, Low-Molecular-Weight; Humans; Infant, Newborn; Morpholines; Polysaccharides; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Pyridines; Rivaroxaban; Societies, Medical; Thiophenes; Thrombophilia; United States; Uterine Hemorrhage; Venous Thromboembolism; Warfarin

Topics: Abruptio Placentae; Adult; Anticoagulants; Enoxaparin; Female; Fibrinogens, Abnormal; Heparin; Humans; Intracranial Thrombosis; Pregnancy; Puerperal Disorders; Stillbirth; Warfarin

A 19-year-old woman, 8 days postpartum, presented to the Emergency Department (ED) with a chief complaint of headache, decreased vision, and agitation. Past medical history was unremarkable. Physical examination was remarkable only for dry mucous membranes, decreased visual acuity, and trace pedal edema bilaterally. While in the ED, the patient experienced a generalized tonic-clonic seizure. Computed tomography (CT) scan of the head was suspicious for venous infarction. Magnetic resonance imaging (MRI) and MR venography revealed sagittal sinus and left transverse sinus thrombosis. The risk factors, clinical presentation, diagnostic evaluation, and management of cerebral venous thrombosis are reviewed.

Topics: Adult; Anticoagulants; Cerebral Angiography; Female; Headache; Humans; Hypertension; Phenytoin; Puerperal Disorders; Risk Factors; Seizures; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

The authors describe a case of DVT during pregnancy in a 41-year-old woman who had a normal haemocoagulative picture during pregnancy and in puerperium (PT, PTT, S protein, C protein, ATIII, xdp and fibrinogenous). All the haemocoagulative dosages were within the norm and compatible with the gestation period. Both homocysteine and antiphospholipid antibodies (mostly in puerperium) were always within normal limits. The authors believe that DVT occurs infrequently but it is also unforeseeable. Systematic heparin prophylaxis for seven to ten days, ante- and postpartum, can prevent this problem.

Topics: Adult; Anticoagulants; Betamethasone; Female; Femoral Vein; Glucocorticoids; Heparin, Low-Molecular-Weight; Humans; Iliac Vein; Platelet Aggregation Inhibitors; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Sulfonamides; Vena Cava, Inferior; Venous Thrombosis; Warfarin

We describe a case where danaparoid was used prophylactically in a high-risk twin pregnancy following the development of heparin-allergy while on prophylactic dalteparin. Danaparoid was substituted for dalteparin at 20 weeks of pregnancy following the development of a severe skin reaction while on the low molecular weight heparin. Although there was no significant fall in platelet count, an aggregation assay for heparin-induced thrombocytopaenia was positive. The skin lesions rapidly resolved following the change to subcutaneous danaparoid. Delivery was by emergency caesarian section at 35 weeks under a general anaesthetic, as a dose of danaparoid had been given 6 h prior to delivery. A sample of breast milk showed no anti-activated factor X activity. Danaparoid was continued post-delivery until the patient was fully warfarinized. To our knowledge, there are no previous reports of the use of danaparoid in this setting.

Topics: Adult; Anticoagulants; Cesarean Section; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Drug Eruptions; Emergencies; Female; Heparin; Heparitin Sulfate; Humans; Infant, Newborn; Injections, Subcutaneous; Platelet Count; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy, High-Risk; Pregnancy, Multiple; Puerperal Disorders; Pulmonary Embolism; Thrombocytopenia; Thrombosis; Warfarin

To investigate the clinical suspicion that postpartum women are more difficult to anticoagulate with warfarin than non-pregnant women due to the physiological changes in coagulation proteins that persist into the postpartum period.. A retrospective case-control study.. University Hospital, Nottingham, UK.. Twenty-three postpartum women discharged from the obstetric wards on warfarin and 23 age-matched control women discharged from the medical wards on warfarin were identified using hospital databases.. Warfarin doses and international normalised ratio values were recorded from day one to 35. The number of days and total warfarin dose to achieve therapeutic international normalised ratio were recorded. Doses were compared with those recommended by a dosing nomogram.. The postpartum group took significantly longer and significantly larger doses of warfarin to reach therapeutic international normalised ratio (P < 0.05). The postpartum group required a persistently higher maintenance dose of warfarin. Comparing the warfarin dose given on day three with a standardised nomogram, 79% of women in the postpartum group compared with 57% in the control group were under-dosed.. Postpartum women require larger doses of warfarin to reach therapeutic international normalised ratio than non-pregnant women. We would recommend the use of a dosing nomogram.

Topics: Adult; Anticoagulants; Blood Coagulation Disorders; Case-Control Studies; Dose-Response Relationship, Drug; Female; Humans; International Normalized Ratio; Pregnancy; Puerperal Disorders; Retrospective Studies; Time Factors; Warfarin

Topics: Anemia; Anticoagulants; Dalteparin; Delivery, Obstetric; Dextrans; Enoxaparin; Female; Hemorrhage; Humans; Length of Stay; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Sweden; Thrombophilia; Thrombosis; Uterine Hemorrhage; Warfarin

Topics: Adult; Anticoagulants; Female; Humans; Necrosis; Puerperal Disorders; Skin; Skin Diseases; Thrombophlebitis; Treatment Refusal; Warfarin

The pregnancy increases the risk of cardiovascular ischemic events, The longitudinal sinus thrombosis is very rare, but the incidence increases during pregnancy and puerperium. The mortality rates range from 25% to 50%. This report consists of a case which was studied and managed at the Military Central Hospital. It occurred on the 12th day post C-S. The diagnostic was confirmed by MRI. The treatment consisted of rest and heparin with a successful development. Our findings agreed with the studies reported at the literature that suggested a beneficial effect with the heparin's use, lowering drastically the mortality rates. Some still oppose to its use because of the risk of an intracranial hemorrhage.

Topics: Adult; Anticoagulants; Cesarean Section; Female; Fibrinolytic Agents; Heparin; Humans; Magnetic Resonance Imaging; Puerperal Disorders; Sinus Thrombosis, Intracranial; Warfarin

Topics: Adult; Female; Heparin; Humans; Pregnancy; Puerperal Disorders; Renal Veins; Thrombosis; Tomography, X-Ray Computed; Warfarin

Topics: Adult; Axillary Vein; Cardiomyopathy, Dilated; Female; Follow-Up Studies; Furosemide; Heparin; Humans; Potassium; Pregnancy; Puerperal Disorders; Thrombosis; Time Factors; Warfarin

Three patients with cerebral venous thrombosis are described. The management of this rare condition is discussed and a case is made for using anticoagulant therapy provided the diagnosis is established before cerebral infarction or hemorrhage have occurred.

Topics: Adult; Epilepsies, Partial; Epilepsy, Tonic-Clonic; Female; Heparin; Humans; Intracranial Embolism and Thrombosis; Pregnancy; Puerperal Disorders; Warfarin

Topics: Blood Coagulation Factors; Breast Feeding; Factor VIII; Factor X; Female; Humans; Infant; Infant, Newborn; Male; Pregnancy; Prothrombin; Prothrombin Time; Puerperal Disorders; Thromboembolism; Warfarin

A case of renal vein thrombosis occurring one week post partum with unknown etiology and excellent recovery is described. Review of the literature reveals this disorder is rare in the nonpregnant woman and even rarer in pregnancy. Survival has greatly improved with anticoagulant use. Diagnosis, prognosis, and treatment are discussed.

Topics: Adult; Female; Humans; Pregnancy; Puerperal Disorders; Renal Veins; Thrombosis; Warfarin

Topics: Dipyridamole; Female; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Thrombosis; Warfarin

Topics: Breast Feeding; Female; Humans; Pregnancy; Puerperal Disorders; Thromboembolism; Warfarin

Topics: Anticoagulants; Computers; Dextrans; Female; Heparin; Humans; Iodine Radioisotopes; Ovarian Diseases; Postoperative Care; Pregnancy; Pregnancy Complications, Cardiovascular; Preoperative Care; Puerperal Disorders; Thromboembolism; Thrombophlebitis; Warfarin

Topics: Adolescent; Adult; Child; Dextrans; Female; Heparin; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Pulmonary Embolism; Thrombophlebitis; Trypsin; Veins; Warfarin

Topics: Axillary Vein; Dicumarol; Female; Femoral Vein; Heparin; Humans; Male; Pregnancy; Puerperal Disorders; Subclavian Vein; Thrombophlebitis; Vena Cava, Inferior; Warfarin

Topics: Anti-Bacterial Agents; Anticoagulants; Drug Therapy; Female; Fever; Genital Diseases, Female; Heparin; Humans; Hysterectomy; Pelvis; Postoperative Complications; Puerperal Disorders; Thrombophlebitis; Warfarin