Ultraschall Med 2010; 31(4): 411-413
DOI: 10.1055/s-0029-1245334
Kasuistik/Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Coumarin Embryopathy after Intrauterine Exposure to Vitamin K Antagonists within the First 10 Postmenstrual Weeks

Coumarin-Embryopathie nach intrauteriner Vitamin-K-Antagonisten-Exposition innerhalb der ersten 10 postmenstruellen WochenA. C. Hoyer, W. Henrich, C. Schaefer, B. Spors, C. Czernik
Further Information

Publication History

received: 5.11.2009

accepted: 26.2.2010

Publication Date:
11 August 2010 (online)

Introduction

Vitamin K antagonists (VKAs) are used for anticoagulation in patients with prosthetic heart valves and with thromboembolism caused by coagulopathies such as antiphospholipid syndrome (APS) (Lim W et al. JAMA 2006; 295: 1050 – 1057; Bates SM et al. Chest 2008; 133: 844S–886S). Vitamin K antagonists cross the placenta and are teratogenic. Chemically diverse VKAs such as warfarin, fluindione, or phenprocoumon are all associated with the same teratogenic pattern which thus appears to be related to vitamin K antagonism itself. Maternal VKA treatment throughout pregnancy is associated with coumarin embryopathy (CE) in up to 7 % of newborns. Cartilage, bone and the developing nervous system contain vitamin K-dependent proteins. Eighty percent of neonates with CE show skeletal anomalies (e. g. mid-face hypoplasia, epiphyseal calcifications), 45 % central nervous malformations (e. g. midline structure defects) and 10 % intracranial hemorrhage. Central nervous malformations may occur when VKAs are given in the 1st trimester. When given in the 2nd and 3rd trimester, intracranial hemorrhage and scarring are the reason for central nervous disorders. The mid-face hypoplasia is considered to be due to ectopic calcification in the septal cartilage, causing a reduction in the longitudinal growth of the nasal septum and associated maxillonasal hypoplasia. There is a controversial discussion as to whether discontinuation of VKAs within the first 6 weeks of pregnancy eliminates the risk of CE. In a European multicenter study based on observational data collected by Teratology Information Services, no cases of CE were noted when VKAs had been discontinued before week 8 after the first day of the last menstrual period (LMP) (Schaefer C et al. Thromb Haemost 2006; 95: 949 – 957).

Dr. Ann Carolin Hoyer

Neonatologie, Universitätsmedizin Berlin-Charité

Augustenburger Platz 1

13353 Berlin

Germany

Phone: ++ 49/30/4 50 56 61 22

Fax: ++ 49/30/4 50 56 69 22

Email: ann-carolin.hoyer@charite.de