Publication:

Low-dose warfarin therapy leading to embryopathy: a case report

The development of specific dysmorphic features known as warfarin embryopathy or fetal warfarin syndrome is more likely to occur in fetuses exposed to maternal consumption of warfarin. Nasal hypoplasia and stippling of the vertebrae or bony epiphysis are the most consistent characteristics. Anticoagulation in pregnant patients might be difficult to manage. According to current recommendations, heparin or low-dose warfarin (≤5 mg/day) should be used. We report the case of a pregnancy where the mother was anticoagulated with low-dose warfarin due to a mechanical mitral valve. Warfarin was required at a dose of 3 and 4 mg on alternate days and was switched to heparin from 10+4 weeks to 12 weeks. Nevertheless, the fetus presented with the signs of warfarin embryopathy. Through this report, we emphasize the need for optimising the choice and dosage of anticoagulants during pregnancy so as to provide the best maternal and fetal outcome.