{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:49:10Z","timestamp":1792259350397,"version":"4.4.0"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,3,11]]},"abstract":"<jats:p>Fetuses exposed to warfarin during pregnancy are at an increased risk of developing an embryopathy known as fetal warfarin syndrome or warfarin embryopathy. The most consistent anomalies are nasal hypoplasia and stippling of vertebrae or bony epiphyses. Management of pregnant patients on anticoagulation is challenging. Current guidelines suggest the use of warfarin if the therapeutic dose is \u22645\u2009mg\/day. We report the case of a newborn with signs of warfarin embryopathy born from a mother anticoagulated with warfarin due to mechanical mitral and aortic heart valves. Warfarin was required at the dose of 5\u2009mg\/day and was withheld without medical advice between weeks 8 and 10 with no other anticoagulation. The newborn presented with skeletal abnormalities and a ventricular septal defect that have not required specific treatment during the first year of life. Low-dose warfarin is associated with a lower risk of warfarin-related fetopathy but the risk of embryopathy seems unchanged.<\/jats:p>","DOI":"10.1136\/bcr-2017-223159","type":"journal-article","created":{"date-parts":[[2018,4,7]],"date-time":"2018-04-07T14:25:19Z","timestamp":1523111119000},"page":"bcr-2017-223159","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Low-dose warfarin maternal anticoagulation and fetal warfarin syndrome"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1825-6373","authenticated-orcid":false,"given":"Ana","family":"R Sousa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Barreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmundo","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,4,7]]},"reference":[{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(80)90181-3"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1980.03300410037022"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.3","first-page":"691","article-title":"Fetal warfarin syndrome","volume":"27","author":"Hou","year":"2004","journal-title":"Chang Gung Med J"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.4","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s00428-010-0982-9","article-title":"Warfarin embryopathy: fetal manifestations","volume":"457","author":"Wainwright","year":"2010","journal-title":"Virchows Arch"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(99)00044-3"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015242"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000458"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.8","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.2.191"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.9","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1093\/eurheartj\/ehx032","article-title":"Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis","volume":"38","author":"D\u2019Souza","year":"2017","journal-title":"Eur Heart J"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.10","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr218"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000029"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.12","doi-asserted-by":"publisher","DOI":"10.1016\/0092-8674(95)90367-4"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.13","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1593418"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-3848(13)70010-0"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01658-1"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.16","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2012-022"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.17","doi-asserted-by":"publisher","DOI":"10.1258\/om.2010.100067"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.18","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/bdra.23435","article-title":"Low-dose maternal warfarin intake resulting in fetal warfarin syndrome: In search for a safe anticoagulant regimen during pregnancy","volume":"106","author":"Basu","year":"2016","journal-title":"Birth Defects Res A Clin Mol Teratol"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.19","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1080\/13816810701537408","article-title":"Optic nerve dysfunction in a child following low-dose maternal warfarin exposure","volume":"28","author":"Khan","year":"2007","journal-title":"Ophthalmic Genet"},{"key":"2025042703205236000_2018.apr07_1.bcr-2017-223159.20","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S1701-2163(16)30550-3","article-title":"Motherisk rounds. 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