Tiffany Herrero1, Erin Martin2, David S Poch3, Hilary A Roeder1. 1. a Department of Reproductive Medicine/Division of Perinatal Medicine , University of California , San Diego , CA , USA. 2. b Department of Anesthesiology , University of California , San Diego , CA , USA. 3. c Department of Pulmonary Critical Care , University of California , San Diego , CA , USA.
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.
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.
Authors: Emily E Naoum; Andrew Chalupka; Jonathan Haft; Mark MacEachern; Cosmas J M Vandeven; Sarah Rae Easter; Michael Maile; Brian T Bateman; Melissa E Bauer Journal: J Am Heart Assoc Date: 2020-06-24 Impact factor: 5.501
Authors: Sylwester P Rogula; Hubert M Mutwil; Aleksandra Gąsecka; Marcin Kurzyna; Krzysztof J Filipiak Journal: Cardiol J Date: 2020-11-17 Impact factor: 2.737