title: Oral anticoagulation therapy during pregnancy in patients with mechanical mitral valves: a prospective study.
abstract: Reports on phenindione toxicity have limited its use as an oral anticoagulant. Our aim was to evaluate its risks in pregnant women. Thirty-one pregnancies in 29 women with mitral (+/-aortic) St. Jude mechanical valves were followed-up prospectively. Eighteen patients received phenindione. Eleven patients (37.9%) received in addition to phenindione 225 mg dipyridamole, which was given in three doses. The target INR was 2.5-3.5 in the former and 2-2.5 in the latter treatment. A fortnight before delivery, intravenous heparinotherapy was substituted. There were no maternal complications, apart from a single postpartum hemorrhage (3.2%). After the deliveries the results were: 26 mature babies (83.9%), 3 premature babies (9.7%) and 2 cases of stillbirth (6.4%). Outcome was dose related; being 57.2+/-20.9 mg/day for mature babies and 82.5+/-11.2 mg/day for prematures and stillbirths (P=0.016). Phenindione provided safe and effective anticoagulation during pregnancy. A larger study is necessary to confirm the relationship between the dosage and outcome.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospital, Cairo, Egypt. ahmedhassouna@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Hassouna
authors.forename: H
authors.initials: H
authors.lastname: Allam
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D004176:Dipyridamole / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019934:International Normalized Ratio; D008429:Maternal Welfare; D008875:Middle Aged; D008943:Mitral Valve / Q000187:drug effects* / Q000473:pathology*; D010630:Phenindione / Q000008:administration & dosage / Q000009:adverse effects; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010630:Phenindione; D004176:Dipyridamole; D006493:Heparin