{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:00:58Z","timestamp":1792800058279,"version":"4.5.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"19","license":[{"start":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T00:00:00Z","timestamp":1489017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5,14]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To review maternal and foetal outcomes in women with mechanical heart valves (MHVs) treated with vitamin-K antagonists (VKAs), first-trimester heparin followed by VKAs (sequential treatment), low molecular weight heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order to inform practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Medline, Embase and Central were searched from inception until February 2016. Two reviewers independently screened 1786 titles, reviewed 110 full-texts and extracted data and assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence intervals) was calculated for maternal and foetal outcomes. Included studies had a moderate or high risk-of-bias. With VKAs, sequential treatment and LMWH, maternal mortality occurred in 0.9% (0.4\u20131.4), 2.0% (0.8\u20133.1) and 2.9% (0.2\u20135.7), thromboembolic complications in 2.7% (1.4\u20134.0), 5.8% (3.8\u20137.7) and 8.7% (3.9\u201313.4), livebirths in 64.5% (48.8\u201380.2), 79.9% (74.3\u201385.6) and 92.0% (86.1\u201398.0) and anticoagulant-related foetal\/neonatal adverse events (embryopathy or foetopathy) in 2.0% (0.3\u20133.7), 1.4% (0.3\u20132.5) and 0%, respectively. When UFH is used throughout pregnancy, 11.2% (2.8\u201319.6) suffered thromboembolic complications. Foetal loss and adverse events occurred with first-trimester warfarin doses\u2009\u2264\u20095\u2009mg\/day, although there were more livebirths [83.6% (75.8\u201391.4) vs. 43.9% (32.8\u201355.0)] and fewer foetal anomalies [2.3% (0.7\u20134.0) vs. 12.4% (3.3\u201321.6)] with lower doses than with warfarin\u2009&amp;gt;\u20095\u2009mg\/day.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>VKAs are associated with fewest maternal complications but also with fewest livebirths. Sequential treatment does not eliminate anticoagulant-related foetal\/neonatal adverse events. LMWH is associated with the highest number of livebirths. The safety of UFH throughout pregnancy and first-trimester warfarin \u2009\u2264\u20095\u2009mg\/day remains unconfirmed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehx032","type":"journal-article","created":{"date-parts":[[2017,1,30]],"date-time":"2017-01-30T08:27:49Z","timestamp":1485764869000},"page":"1509-1516","source":"Crossref","is-referenced-by-count":183,"title":["Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"38","author":[{"given":"Rohan","family":"D\u2019Souza","sequence":"first","affiliation":[{"name":"1Department of Obstetrics and Gynaecology, Division of Maternal and Fetal Medicine, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada"},{"name":"2Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto ON M5T 3M6, 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