Bleeding and thrombotic risk in pregnant women with Fontan physiology

Background/objectives Pregnancy may potentiate the inherent hypercoagulability of the Fontan circulation, thereby amplifying adverse events. This study sought to evaluate thrombosis and bleeding risk in pregnant women with a Fontan.  Methods We performed a retrospective observational cohort study across 13 international centres and recorded data on thrombotic and bleeding events, antithrombotic therapies and pre-pregnancy thrombotic risk factors.  Results We analysed 84 women with Fontan physiology undergoing 108 pregnancies, average gestation 33 +/- 5 weeks. The most common antithrombotic therapy in pregnancy was aspirin (ASA, 47 pregnancies (43.5%)). Heparin (unfractionated (UFH) or low molecular weight (LMWH)) was prescribed in 32 pregnancies (30%) and vitamin K antagonist (VKA) in 10 pregnancies (9%). Three pregnancies were complicated by thrombotic events (2.8%). Thirty-eight pregnancies (35%) were complicated by bleeding, of which 5 (13%) were severe. Most bleeds were obstetric, occurring antepartum (45%) and postpartum (42%). The use of therapeutic heparin (OR 15.6, 95% CI 1.88 to 129, p=0.006), VKA (OR 11.7, 95% CI 1.06 to 130, p=0.032) or any combination of anticoagulation medication (OR 13.0, 95% CI 1.13 to 150, p=0.032) were significantly associated with bleeding events, while ASA (OR 5.41, 95% CI 0.73 to 40.4, p=0.067) and prophylactic heparin were not (OR 4.68, 95% CI 0.488 to 44.9, p=0.096). Conclusions Current antithrombotic strategies appear effective at attenuating thrombotic risk in pregnant women with a Fontan. However, this comes with high (>30%) bleeding risk, of which 13% are life threatening. Achieving haemostatic balance is challenging in pregnant women with a Fontan, necessitating individualised risk-adjusted counselling and therapeutic approaches that are monitored during the course of pregnancy

Standar perawatan pasien: Proses keperawatan, diagnosis dan evaluasi Vol. 4

xvii, 315 hlm.; 27 c

Standar perawatan pasien: Proses keperawatan, diagnosis, dan evaluasi=Patient care standards: Nursing process, dianosis, and outcome

IX+1017hlm.;27c

The International Adult Congenital Heart Disease Nursing Network: coming together for the future

status: publishe

Standar perawatan pasien: Proses keperawatan, diagnosis dan evaluasi Vol. 1

xvi, 222 hlm.; 27 c

Patient care Standards: Nursing process, diagnosis, and outcome

xvii, 920 hlm.; ilus.; 28 c

PAN-00017228 - block weight of lead cast with relief

This find is registered at Portable Antiquities of the Netherlands with number PAN-0001722

Standar perawatan pasien proses keperawatan, diagnosa, dan evaluasi

xvi, 221 hlm; 21x27 c