Anti-coagulation complications in pregnancies with severe pulmonary arterial hypertension. (3rd May 2018)

• Record Type: Journal Article
• Authors: Herrero, Tiffany; Martin, Erin; Poch, David S.; Roeder, Hilary A.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 9(2018)
• Page Start: 1209
• Page End: 1213
• Publication Date: 2018-05-03
• Subjects: Pregnancy -- pulmonary hypertension -- anti-coagulation -- thrombocytopenia -- thromboprophylaxis; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1312329
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Background: Epoprostenol, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) in pregnancy. However, its inhibition of platelet aggregation increases the risk of coagulation complications with conjunctive use of anti-coagulants for thromboprophylaxis. Cases: Case 1 demonstrates a pregnancy complicated by thrombocytopenia. Case 2 describes a pregnancy with newly diagnosed PAH at 35 weeks who delivered by repeat cesarean delivery complicated by a wound hematoma. Case 3 describes a patient who delivered at 32 weeks. She required extracorporeal membrane oxygenation and a heart–lung transplant. Her care was further complicated by severe thrombocytopenia with postpartum hemorrhage refractory to usual conservative measures. Conclusions: This case series describes three patients with severe PAH in pregnancy and the range of different complications that arose from anticoagulation in the setting of epoprostenol.