R Sousa Ana, Barreira Rita, Santos Edmundo
Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.
Department of Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.
BMJ Case Rep. 2018 Apr 7;2018:bcr-2017-223159. doi: 10.1136/bcr-2017-223159.
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 ≤5 mg/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 mg/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.
孕期接触华法林的胎儿发生一种名为胎儿华法林综合征或华法林胚胎病的胚胎病风险增加。最常见的异常是鼻发育不全以及椎骨或骨骨骺点状钙化。对抗凝治疗的孕妇进行管理具有挑战性。当前指南建议，如果治疗剂量≤5毫克/天，则使用华法林。我们报告了一例患有华法林胚胎病体征的新生儿病例，其母亲因机械性二尖瓣和主动脉瓣心脏瓣膜而接受华法林抗凝治疗。所需华法林剂量为5毫克/天，在孕8至10周期间未经医嘱停用，且未进行其他抗凝治疗。该新生儿出现骨骼异常和室间隔缺损，在出生后第一年无需特殊治疗。低剂量华法林与华法林相关胎儿病风险较低相关，但胚胎病风险似乎未变。
