Akademik Veri Yönetim Sistemi
9th European Congress of Pharmacology, Athens, Yunanistan, 23 - 26 Haziran 2024, ss.181
Introduction: Direct-acting oral anticoagulants (DOACs) are among the drug classes with an increasing utilization trend in the community [1]. Various concerns regarding the use of the drug in women of childbearing age accompany the lack of knowledge about the potential teratogenic effects of exposure during pregnancy. We aimed to evaluate outcomes of DOAC exposure in pregnant women referred to a teratology information service (TIS). Methods: We examined the admissions to Marmara University TIS for DOAC use during pregnancy between 2017 and 2023. The DOACs used by the cases, the indications for using these drugs, the duration of drug exposure, the results of the teratology risk assessment reports for the consulted cases, and the relevant pregnancy outcomes were evaluated. Results: Six pregnant women on DOACs were identified throughout the study period, five on rivaroxaban and one on dabigatran. The mean age at the time of admission was 33.3±6.7 (range: 25-40 years). All except one of the cases (83.3%) were consulted to our service in the first trimester of the pregnancy, and the mean gestational age at admission was 7.8±2.7 weeks (range: 6-13 weeks). The most common indication for DOAC use was pulmonary embolism, which was encountered in four cases (66.7%). The mean duration of DOAC exposure was 5.5±1.9 weeks. Fifty percent of the teratology risk assessment reports included recommendation to “avoid use/change to another anticoagulant”. Out of five cases with known pregnancy outcomes, two were terminated. One of the terminations was performed due to Tay-Sachs disease, which was also diagnosed in the siblings, and the other one was elective. Among the three live births, one was diagnosed with atypical autism spectrum disorder and speech delay, another had low birth weight and strabismus, and the third experienced hypoglycemia during the first week after birth. Conclusions: This study revealed abnormal outcomes in the children of mothers exposed to DOACs, without any specific pattern. While these results suggest the potential role of underlying diseases in the occurrence of adverse pregnancy outcomes, they do not appear sufficient to conclusively rule out the potential contribution of DOAC exposure.
[1] Costa LSD, Alsultan MM, Hincapie AL, Guo JJ. Trends in utilization, reimbursement, and price for DOACs and warfarin in the US Medicaid population from 2000 to 2020. J Thromb Thrombolysis. 2023;55(2):339-345.