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Antithrombotic Therapy for Cardiac Disorders in Pregnancy

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Disorders of Thrombosis and Hemostasis in Pregnancy

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Abstract

Pregnancy is a prothrombotic state and it is therefore essential that women with heart disease embarking on pregnancy have an assessment of cardiac risk as well as their risk of venous thromboembolism. Even in the non-pregnant state many women with heart disease require thromboprophylaxis with antiplatelet agents or oral vitamin K antagonists. In this chapter we discuss how these prior treated patients are managed during pregnancy, as well as highlighting other patient groups that should be considered for thromboprophylaxis only while pregnant.

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References

  1. Arafeh JM, Baird SM. Cardiac disease in pregnancy. Crit Care Nurs Q. 2006;29:32–52.

    PubMed  Google Scholar 

  2. Lewis G, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer – 2003–2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH; 2007.

    Google Scholar 

  3. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S, Cardiac Disease in Pregnancy (CARPREG) Investigators. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515–21.

    Article  PubMed  CAS  Google Scholar 

  4. Siu SC, Sermer M, Harrison DA, Grigoriadis E, Liu G, Sorensen S, Smallhorn JF, Farine D, Amankwah KS, Spears JC, Colman JM. Risk and predictors for pregnancy-related complications in women with heart ­disease. Circulation. 1997;96:2789–94.

    Article  PubMed  CAS  Google Scholar 

  5. Walker F. In: Steer PJ, Gatzoulis MA, Baker P, editors. Antenatal care of women with cardiac disease: a cardiologists perspective. Heart disease and pregnancy. London: RCOG Press; 2006.

    Google Scholar 

  6. Klinzing P, Markert UR, Liesaus K, Peiker G. Case report: successful pregnancy and delivery after myocardial infarction and essential thrombocythemia treated with clopidrogel. Clin Exp Obstet Gynecol. 2001;28:215–6.

    PubMed  CAS  Google Scholar 

  7. Cuthill JA, Young S, Greer IA, Oldroyd K. Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section. Int J Obstet Anesth. 2005;14:167–71.

    Article  PubMed  CAS  Google Scholar 

  8. Taguchi K. Pregnancy in patients with a prosthetic heart valve. Surg Gynecol Obstet. 1977;145:2068.

    Google Scholar 

  9. Nassar AH, Hobeika EM, Abd Essamad HM, Taher A, Khalil AM, Usta IM. Pregnancy outcome in women with prosthetic heart valves. Am J Obstet Gynecol. 2004;191:1009–13.

    Article  PubMed  Google Scholar 

  10. Blickstein D, Blickstein I. The risk of fetal loss associated with Warfarin anticoagulation. Int J Gynaecol Obstet. 2002;78:221–5.

    Article  PubMed  CAS  Google Scholar 

  11. Srivastava AK, Gupta AK, Singh AV, Husain T. Effect of oral anticoagulant during pregnancy with prosthetic heart valve. Asian Cardiovasc Thorac Ann. 2002;10:306–9.

    PubMed  Google Scholar 

  12. Hall JG. Embryopathy associated with oral anticoagulant therapy. Birth Defects. 1965;12:133–40.

    Google Scholar 

  13. Iturbe-Alessio I, Fonseca MC, Mutchinik O, Santos MA, Zajarias A, Salazar E. Risks of anticoagulant therapy in pregnant women with artificial heart valves. N Engl J Med. 1986;315:1390–3.

    Article  PubMed  CAS  Google Scholar 

  14. Sadler L, McCowan L, White H, Stewart A, Bracken M, North R. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG. 2000;107:245–53.

    Article  PubMed  CAS  Google Scholar 

  15. Meschengieser SS, Fondevila CG, Santarelli MT, Lazzari MA. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart. 1999;82:23–6.

    PubMed  CAS  Google Scholar 

  16. Chen WW, Chan CS, Lee PK, Wang RY, Wong VC. Pregnancy in patients with prosthetic heart valves: an experience with 45 pregnancies. Q J Med. 1982;51:358–65.

    PubMed  CAS  Google Scholar 

  17. Hall JAG, Paul RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med. 1980;68:122–40.

    Article  PubMed  CAS  Google Scholar 

  18. Wesseling J, Van Driel D, Heymans HSA, Rosendaal FR, Geven-Boere LM, Smrkovsky M, Touwen BCL, Sauer PJJ Van der Veer E. Coumarins during pregnancy: Long-term effects on growth and development of school-age children. Thrombosis and Haemostasis. 2001;85(4):609–13.

    PubMed  CAS  Google Scholar 

  19. Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation. 2003;107:1240–6.

    Article  PubMed  Google Scholar 

  20. Cotrufo M, De Feo M, De Santo LS, Romano G, Della Corte A, Renzulli A, Gallo C. Risk of warfarin during pregnancy with mechanical valve prostheses. Obstet Gynecol. 2002;99:35–40.

    Article  PubMed  CAS  Google Scholar 

  21. Eikelboom JW, Hirsh J. Monitoring unfractionated heparin with the aPTT: time for a fresh look. Thromb Haemost. 2006;96(5):547–52.

    PubMed  CAS  Google Scholar 

  22. Thromboembolic disease in pregnancy and the puerperium: Acute management. Royal College of Obstetri­cians and Gynaecologists. Green-top guideline no.37b, February 2007. Reviewed 2010. London: RCOG.

    Google Scholar 

  23. Schaefer DC, Hufnagle J, Williams L. Rapid heparin anticoagulation: use of a weight-based nomogram. Am Fam Physician. 1996;54:2517–21.

    Google Scholar 

  24. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos A-M, Vandvik PO. VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest February 2012 141(2): e691S–36.

    Google Scholar 

  25. Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, Kelton JG. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight-heparin or unfractionated heparin. NEJM. 1995;332:1330–6.

    Article  PubMed  CAS  Google Scholar 

  26. Girolami B, Prandoni P, Stefani PM, Tanduo C, Sabbion P, Eichler P, Ramon R, Baggio G, Fabris F, Girolami A. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood. 2003;101:2955–9.

    Article  PubMed  CAS  Google Scholar 

  27. Barbour LA, Kick SD, Steiner JF, LoVerde ME, Heddleston LN, Lear JL, Baron AE, Barton PL. A prospective study of heparin-induced osteoporosis in pregnancy using bone densitometry. Am J Obstet Gynecol. 1994;170:862–9.

    PubMed  CAS  Google Scholar 

  28. Dahlman, TC. Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin. American Journal of Obstetrics and Gynecology. 1993;168(4):1265–70.

    Article  PubMed  CAS  Google Scholar 

  29. Royal College of Obstetricians and Gynaecologists. Green-top guideline no. 37a. Thrombosis and embolism during pregnancy and the puerperium, Reducing the risk. London. Royal College of Obstetricians and Gynaecologists; 2009.

    Google Scholar 

  30. Oran B, Lee-Parritz A, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb Haemost. 2004;92:747–51.

    PubMed  CAS  Google Scholar 

  31. James AH, Brancazio LR, Gehrig TR, Wang A, Ortel TL. Low-molecular-weight heparin for thromboprophylaxis in pregnant women with mechanical heart valves. J Matern Fetal Neonatal Med. 2006;19:543–9.

    Article  PubMed  CAS  Google Scholar 

  32. Bazzan M, Donvito V. Low molecular weight heparin during pregnancy. Thromb Res. 2001;101:V175–86.

    Article  PubMed  CAS  Google Scholar 

  33. Sanson BJ, Lensing AW, Prins MH, Ginsberg JS, Barkagan ZS, Lavenne-Pardonge E, Brenner B, Dulitzky M, Nielsen JD, Boda Z, Turi S, Mac Gillavry MR, Hamulyak K, Theunissen IM, Hunt BJ, Buller HR. Safety of low-molecular-weight heparin in pregnancy: a systematic review. Thromb Haemost. 1999;81:668–72.

    PubMed  CAS  Google Scholar 

  34. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005;106:401–7.

    Article  PubMed  CAS  Google Scholar 

  35. Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI, American College of Chest Physicians. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133 Suppl 6:141S–59.

    Article  PubMed  CAS  Google Scholar 

  36. Quinn J, Von Klemperer K, Brooks R, Peebles D, Walker F, Cohen H. Use of high intensity adjusted dose low molecular weight heparin in women with mechanical heart valves during pregnancy: a single-center experience. Haematologica. 2009;94:1608–12.

    Article  PubMed  CAS  Google Scholar 

  37. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.

    Article  PubMed  Google Scholar 

  38. Vijaykumar M, Narula J, Reddy KS. Incidence of rheumatic fever and prevalence of rheumatic heart disease in India. Int J Cardiol. 1994;43:221–8.

    Article  PubMed  CAS  Google Scholar 

  39. Agarwal AK. Rheumatic fever and rheumatic heart disease in Arabia. Int J Cardiol. 1994;43:221–8.

    Article  Google Scholar 

  40. Personal communication with Dr. Lorna Swan, ­consultant cardiologist, Royal Brompton Hospital, London, and Dr. Sara Thorne, consultant cardiologist, University Hospital Birmingham, Birmingham. 2010.

    Google Scholar 

  41. British Society of Echocardiography guidelines for chamber quantification. www.bsecho.org.

  42. Curry R, Swan L, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol. 2009;21:508–13.

    Article  PubMed  Google Scholar 

  43. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, Giambartolomei A, Diver DJ, Lasorda DM, Williams DO, Pocock SJ, Kuntz RE. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339:1665–71.

    Article  PubMed  CAS  Google Scholar 

  44. Urban P, Macaya C, Rupprecht HJ, Kiemeneij F, Emanuelsson H, Fontanelli A, Pieper M, Wesseling T, Sagnard L. Randomized evaluation of anticoagulation versus antiplatelet therapy after coronary stent implantation in high-risk patients: the multicenter aspirin and ticlopidine trial after intracoronary stenting (MATTIS). Circulation. 1998;98(20):2126–32.

    Article  PubMed  CAS  Google Scholar 

  45. Brener SJ, Steinhubl SR, Berger PB, Brennan DM, Topol EJ, for the CREDO Investigators. Prolonged dual antiplatelet therapy after percutaneous coronary intervention reduces ischemic events without affecting the need for repeat revascularization: insights from the CREDO trial. J Invasive Cardiol. 2007;19:287–90.

    PubMed  Google Scholar 

  46. Galla JM, Lincoff AM. The role of clopidogrel in the management of ischemic heart disease. Curr Opin Cardiol. 2007;22:273–9.

    PubMed  Google Scholar 

  47. Bonow RO, Carabello BA, Chatterjee K, de Leon Jr AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e1–142.

    Article  PubMed  Google Scholar 

  48. Keeling, D, Davidson, S, Watson, H and British Comm Standards, H. The management of heparin-induced thrombocytopenia. British Journal of Haematology. 2006;133(3):259–69

    Google Scholar 

  49. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A, Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68.

    PubMed  Google Scholar 

  50. Chan WS, Anand S and Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves - A systematic review of the literature. Archives of Internal Medicine. 2000;160(2):191–6.

    Google Scholar 

  51. Ginsberg JS, Chan WS, Bates SM, Kaatz S. Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med. 2003;163:694–8.

    Google Scholar 

  52. Yinon Y, Siu SC, Warshafsky C, Maxwell C, McLeod A, Colman JM, Sermer M, Silversides CK. Use of low molecular weight heparin in pregnant women with mechanical heart valves. Am J Cardiol. 2009;104(9):1259–63.

    Google Scholar 

  53. McLintock C, McCowan LM, North RA. Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with ­enoxaparin. BJOG. 2009;116(12):1585–92.

    Article  PubMed  CAS  Google Scholar 

  54. Raschke R, Gollihare B, Peirce J. The effectiveness of implementing the weight-based heparin nomogram as a practice guideline. Arch Intern Med. 1996;156:1645–9.

    Article  PubMed  CAS  Google Scholar 

  55. Elkayam U, Khan S, Mehboob A, Ahsan N. Impaired endothelium-mediated vasodilation in heart failure: clinical evidence and the potential for therapy. J Card Fail. 2002;8:15–20.

    Article  PubMed  CAS  Google Scholar 

  56. Ahnert AM, Freudenberger RS. What do we know about anticoagulation in patients with heart failure? Curr Opin Cardiol. 2008;23:228–32.

    Article  PubMed  Google Scholar 

  57. Chong AY, Freestone B, Patel J, Lim HS, Hughes E, Blann AD, Lip GY. Endothelial activation, dysfunction, and damage in congestive heart failure and the relation to brain natriuretic peptide and outcomes. Am J Cardiol. 2006;97:671–5.

    Article  PubMed  CAS  Google Scholar 

  58. Abdo AS, Kemp R, Barham J, Geraci SA. Dilated ­cardiomyopathy and role of antithrombotic therapy. Am J Med Sci. 2010;339(6):557–60.

    PubMed  Google Scholar 

  59. Cleland JG, Findlay I, Jafri S, Sutton G, Falk R, Bulpitt C, Prentice C, Ford I, Trainer A, Poole-Wilson PA. The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J. 2004;148:157–64.

    Article  PubMed  CAS  Google Scholar 

  60. Grewal J, Siu SC, Ross HJ, Mason J, Balint OH, Sermer M, Colman JM, Silversides CK. Pregnancy outcomes in women with dilated cardiomyopathy. J Am Coll Cardiol. 2009;55:45–52.

    Article  PubMed  Google Scholar 

  61. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368:687–93.

    Article  PubMed  Google Scholar 

  62. Sutton MS, Cole P, Plappert M, Saltzman D, Goldhaber S. Effects of subsequent pregnancy on left ventricular function in peripartum cardiomyopathy. Am Heart J. 1991;121(6 Pt 1):1776–8.

    Article  PubMed  CAS  Google Scholar 

  63. Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR, Hameed A, Gviazda I, Shotan A. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001;344(21):1567–71.

    Article  PubMed  CAS  Google Scholar 

  64. Kajimoto H, Nakazawa M, Murasaki K, Hagiwara N, Nakanishi T. Increased P-selectin expression on platelets and decreased plasma thrombomodulin in Fontan patients. Circ J. 2009;73:1705–10.

    Article  PubMed  CAS  Google Scholar 

  65. Odegard KC, McGowan Jr FX, Zurakowski D, Dinardo JA, Castro RA, del Nido PJ, Laussen PC. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg. 2003;125:1260–7.

    Article  PubMed  Google Scholar 

  66. Varma C, Warr MR, Hendler AL, Paul NS, Webb GD, Therrien J. Prevalence of “silent” pulmonary emboli in adults after the Fontan operation. J Am Coll Cardiol. 2003;41:2252–8.

    Article  PubMed  Google Scholar 

  67. Monagle P, Cochrane A, McCrindle B, Benson L, Williams W, Andrew M. Thromboembolic complications after Fontan procedures – the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg. 1998;115:493–8.

    Article  PubMed  CAS  Google Scholar 

  68. Wood P. Pulmonary hypertension with special ­reference to the vasoconstrictive factor. Br Heart J. 1958;20:557–70.

    Article  PubMed  CAS  Google Scholar 

  69. Perloff JK, Rosove MH, Child JS, Wright GB. Adults with cyanotic congenital heart disease: hematologic management. Ann Intern Med. 1988;109:406–13.

    PubMed  CAS  Google Scholar 

  70. Lill MC, Perloff JC, Child JS. Pathogenesis of thrombocytopenia in cyanotic congenital heart disease. Am J Cardiol. 2006;98(2):254–8.

    Article  PubMed  CAS  Google Scholar 

  71. Huber K, Beckmann R, Frank H, Kneussl M, Mlczoch J, Binder BR. Fibrinogen, t-PA, and PAI-1 plasma levels in patients with pulmonary hypertension. Am J Respir Crit Care Med. 1994;150:929–33.

    PubMed  CAS  Google Scholar 

  72. Diller GP, Gatzoulis MA. Pulmonary vascular disease in adults with congenital heart disease. Circulation. 2007;115:1039–50.

    Article  PubMed  Google Scholar 

  73. Broberg CS, Ujita M, Prasad S, Li W, Rubens M, Bax BE, Davidson SJ, Bouzas B, Gibbs JS, Burman J, Gatzoulis MA. Pulmonary arterial thrombosis in eisenmenger syndrome is associated with biventricular dysfunction and decreased pulmonary flow ­velocity. J Am Coll Cardiol. 2007;50:634–42.

    Article  PubMed  Google Scholar 

  74. Daliento L, Somerville J, Presbitero P, Menti L, Brach-Prever S, Rizzoli G, Stone S. Eisenmenger syndrome. Factors relating to deterioration and death. Eur Heart J. 1998;19:1845–55.

    Article  PubMed  CAS  Google Scholar 

  75. Warnes CA. Pregnancy and pulmonary hypertension. Int J Cardiol. 2004;97 Suppl 1:11–3.

    Article  PubMed  Google Scholar 

  76. Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J. 2009;30:256–65.

    Article  PubMed  Google Scholar 

  77. Presbitero P, Somerville J, Stone S, Aruta E, Spiegel­halter D, Rabajoli F. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation. 1994;89(6):2673–6.

    Article  PubMed  CAS  Google Scholar 

  78. Toglia MR, Weg JG. Venous thromboembolism during pregnancy. N Engl J Med. 1996;335:108–14.

    Article  PubMed  CAS  Google Scholar 

  79. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet. 1999;353:1258–65.

    Article  PubMed  CAS  Google Scholar 

  80. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, van Dijk AP, Vliegen HW, Yap SC, Moons P, Ebels T, van Veldhuisen DJ, ZAHARA Investigators. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49(24):2303–11.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Ruth Brooks, cardiac specialist nurse for the maternal cardiology service at the Heart Hospital, for her input.

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Authors and Affiliations

  1. The Heart Hospital, University College London Hospitals NHS Trust, 16-18 Westmoreland St, London, UK

    Anna Herrey MD, PhD, MRCP

  2. Department of Haematology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK

    Hannah Cohen MD, FRCP, FRCPath

  3. The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK

    Fiona Walker BM(Hons), FRCP, FESC

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  1. Anna Herrey MD, PhD, MRCP
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  2. Hannah Cohen MD, FRCP, FRCPath
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  3. Fiona Walker BM(Hons), FRCP, FESC
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Correspondence to Fiona Walker BM(Hons), FRCP, FESC .

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Editors and Affiliations

  1. Aberdare Gardens 36, London, NW6 3QA, United Kingdom

    Hannah Cohen

  2. Dept. Obstetrics & Gynaecology, University College Hospital, Chenies Mews 86-96, London, WC1E 6HX, United Kingdom

    Patrick O'Brien

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Herrey, A., Cohen, H., Walker, F. (2012). Antithrombotic Therapy for Cardiac Disorders in Pregnancy. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, London. https://doi.org/10.1007/978-1-4471-4411-3_7

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