<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412021000100043</article-id>
<article-id pub-id-type="doi">10.24245/gom.v89i1.4669</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Anticoagulación en embarazadas con válvula mecánica cardiaca: reto clínico para el equilibrio materno y fetal]]></article-title>
<article-title xml:lang="en"><![CDATA[Anticoagulation in pregnant women with mechanical heart valve: clinical challenge for maternal and fetal balance]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Muñoz-Ortiz]]></surname>
<given-names><![CDATA[Edison]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Velásquez-Penagos]]></surname>
<given-names><![CDATA[Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gándara-Ricardo]]></surname>
<given-names><![CDATA[Jairo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Holguín]]></surname>
<given-names><![CDATA[Erica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peláez]]></surname>
<given-names><![CDATA[Marcela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Betancur-Pizarro]]></surname>
<given-names><![CDATA[Ana Milena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Velásquez]]></surname>
<given-names><![CDATA[Oscar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jaramillo]]></surname>
<given-names><![CDATA[Carlos José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital San Vicente Fundación Clínica de Embarazo y Enfermedad Cardiaca ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Antioquia Departamento de Medicina Interna Sección de Cardiología]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad de Antioquia Departamento de Gineco-Obstetricia ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2021</year>
</pub-date>
<volume>89</volume>
<numero>1</numero>
<fpage>43</fpage>
<lpage>50</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412021000100043&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412021000100043&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412021000100043&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  ANTECEDENTES: Suspender la anticoagulación en la mujer embarazada con una válvula mecánica no es una opción. Los diferentes esquemas de anticoagulación ofrecen ventajas y desventajas a la madre y al feto. La muerte materna y los fenómenos tromboembólicos asociados con trombosis de válvulas mecánicas son desenlaces susceptibles de evitarse con un adecuado tratamiento y seguimiento.  OBJETIVO: Describir los desenlaces perinatales y cardiovasculares en embarazadas con válvulas cardiacas mecánicas, según el tipo de anticoagulante indicado y las recomendaciones revisadas en la bibliografía.  METODOLOGÍA: Estudio retrospectivo efectuado con base en la búsqueda bibliográfica de los MeSH: &#8220;anticoagulants&#8221;; &#8220;heart valve diseases&#8221;; &#8220;pregnancy&#8221;; &#8220;mechanical heart valves&#8221; y &#8220;outcomes&#8221;de artículos publicados en PubMed del año 2000 al 2020. Se seleccionaron artículos de sociedades científicas, revisiones sistemáticas y series de casos que compararan diferentes esquemas terapéuticos.  RESULTADOS: Se obtuvieron 118 artículos de los que se excluyeron 105 por: duplicidad, anteriores al año 2000, ser revisiones narrativas, reportes de caso y por no establecer comparaciones terapéuticas. 13 cumplieron con los criterios y motivaron el análisis.  CONCLUSIONES: Con la evidencia disponible es posible soportar decisiones en consenso con la paciente. Los esquemas que incorporan warfarina a dosis baja para mantener el índice internacional normalizado (INR) adecuado son seguros para la madre y el feto. La indicación de heparinas de bajo peso molecular en el primer trimestre debe guiarse, siempre, con la medición de las concentraciones del antifactor Xa; de lo contrario, deberá hospitalizarse a la paciente y administrarle una infusión con heparina no fraccionada. La atención debe ofrecerse en instituciones con experiencia en estos procedimientos.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  BACKGROUND: Stopping anticoagulation in a pregnant woman with a mechanical valve is not an option. The different anticoagulation schemes offer advantages and disadvantages to the mother and the fetus. Maternal death and thromboembolic phenomena associated with mechanical valve thrombosis are outcomes that can be avoided with appropriate treatment and follow-up.  OBJECTIVE: To describe the perinatal and cardiovascular outcomes in pregnant women with mechanical heart valves, according to the type of anticoagulant indicated and the recommendations reviewed in the literature.  METHODOLOGY: Retrospective study based on the bibliographic search of the MeSH: &#8220;anticoagulants&#8221;; &#8220;heart valve diseases&#8221;; &#8220;pregnancy&#8221;; &#8220;mechanical heart valves&#8221; and &#8220;outcomes&#8221; of articles published in PubMed from 2000 to 2020. Articles from scientific societies, systematic reviews and case series comparing different therapeutic schemes were selected.  RESULTS: 118 articles were obtained from which 105 were excluded because they were duplicated, prior to the year 2000, they were narrative reviews, case reports and because therapeutic comparisons were not established. 13 met the criteria and motivated the analysis.  CONCLUSIONS: With the available evidence it is possible to support decisions in consensus with the patient. Schemes incorporating low-dose warfarin to maintain the appropriate international normalized ratio (INR) are safe for mother and fetus. The indication for low-molecular-weight heparins in the first trimester should always be guided by measuring concentrations of anti-factor Xa; otherwise, the patient should be hospitalized and given an infusion of unfractionated heparin. Care should be offered at institutions with experience in these procedures.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Anticoagulación]]></kwd>
<kwd lng="es"><![CDATA[embarazo]]></kwd>
<kwd lng="es"><![CDATA[muerte materna]]></kwd>
<kwd lng="es"><![CDATA[feto]]></kwd>
<kwd lng="es"><![CDATA[tromboembólico]]></kwd>
<kwd lng="es"><![CDATA[válvulas cardiacas]]></kwd>
<kwd lng="es"><![CDATA[enfermedades del embarazo]]></kwd>
<kwd lng="es"><![CDATA[warfarina]]></kwd>
<kwd lng="es"><![CDATA[heparinas de bajo peso molecular, primer trimestre]]></kwd>
<kwd lng="en"><![CDATA[Anticoagulation]]></kwd>
<kwd lng="en"><![CDATA[Pregnancy]]></kwd>
<kwd lng="en"><![CDATA[Fetus maternal death]]></kwd>
<kwd lng="en"><![CDATA[Thromboembolic]]></kwd>
<kwd lng="en"><![CDATA[Heart valves]]></kwd>
<kwd lng="en"><![CDATA[Disease pregnancy]]></kwd>
<kwd lng="en"><![CDATA[Warfarin]]></kwd>
<kwd lng="en"><![CDATA[Fetus]]></kwd>
<kwd lng="en"><![CDATA[Low molecular weight heparins]]></kwd>
<kwd lng="en"><![CDATA[Firs trimester]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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