title: Warfarin-associated fetal intracranial hemorrhage in woman with mitral valve replacements: a case report.
abstract: Warfarin-associated fetal hemorrhage is a fatal event. We report the case of a 39-year-old woman who had been taking warfarin for 23 years since undergoing mitral valve replacement. Thereafter, when she was found to be pregnant, the medication was switched to heparin from 6 to 21 weeks of gestation. Following this, she was prescribed oral warfarin again (3.5 mg per day), with a strict control of prothrombin time/international normalized ratio (PT/INR). At 23 weeks of gestation, fetal intracranial hemorrhage occurred because of maternal exposure to warfarin. Maternal PT/INR does not correlate well with the activity of warfarin in the fetus and currently, there is no direct way to prevent fetal intracranial hemorrhage. Hence, further research on the optimal coagulation therapy in pregnant women with valve replacement should be encouraged.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uehara
authors.forename: Keiko
authors.initials: K
authors.lastname: Mekaru
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Uezato
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sakumoto
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Aoki
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000139:chemically induced*; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000517:prevention & control*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin