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Warfarin - can it cause miscarrige when given in pregnancy?

MagazineFebruary 1993 (Vol. 3 Issue 11)Warfarin - can it cause miscarrige when given in pregnancy?

Q:Our baby was pronounced dead in utero on 27 December 1991, at 28 weeks gestation

Q:Our baby was pronounced dead in utero on 27 December 1991, at 28 weeks gestation. She was induced stillborn three days later.

Eight days prior to the 27th, an addition to the drug regime was implemented due to possible complications, which may have affected the mother's health, in the opinion of our doctor. The drug was the anti-coagulant warfarin.The post mortem conclusion was placental insufficiency, and we were assured that the death was in no way related to the drug administered. The baby was apparently perfect in every way.

We are considering possible litigation, and would be interested in any comments that What Doctors Don't Tell You may have on this incident and whether any similar cases have come to your attention. N. E. J., Leyton......

A:We are so sorry to hear of your tragic story. We believe that your suspicions are likely to be correct. Neither the coroner nor your medical team appear to be familiar with the clear warnings the various manufacturers of warfarin have published in doctors' guides like the Data Sheet Compendium or the Physician's Desk Reference, which are supposed to be consulted before a doctor prescribes a drug.

In the PDR entry for the product Panwarfin (a warfarin tablet), Abbott Laboratories lists "pregnancy" as a contraindication (condition when the drug should not be given) and notes the following:

"Panwarfin is contraindicated in pregnancy because the drug passes through the placental barrier and may cause fatal haemorrhage to the foetus in utero. Furthermore, there have been reports of birth malformations in children born to mothers who have been treated with warfarin during pregnancy. Women of childbearing potential who are candidates for anticoagulant therapy should be carefully evaluated and the indications critically reviewed with the patient. If the patient becomes pregnant while taking this drug, she should be apprised of the potential risks to the foetus, and the possibility of termination of the pregnancy should be discussed in light of those risks."

The listing in the ordinarily tame British Data Sheet Compendium for Marevan, produced by Duncan, Flockhart & Co is equally emphatic about avoiding warfarin during pregnancy. It says that "Oral anticoagulants should not be used in pregnancy particularly because of possible teratogenicity [birth defects] and the risk of foetal haemorrhage near term". Duncan, Flockhart recommends that heparin(which does not cross the placenta), rather than warfarin, should be during the first trimester and after 37 week's gestation. "However, the use of heparin in pregnancy is not absolutely safe and specialist guidance is advisable for those who are pregnancy and who need anticoagulant therapy. Women of childbearing age who are receiving treatment with Marevan should be cautioned about the possible complications of pregnancy."

It doesn't sound to us as though you were given any warning of the known potential risk to your baby. We urge you to take action against what appears to be a blatant case of negligence.

For the benefit of our many other readers, who have written in with fears about this potent and highly dangerous drug, we'd like to share a recent article published by noted health writer Stephen Fulder in the Townsend Letter for Doctors which we alluded to last month. This may also help your partner, should she again suffer a risk of coronary thrombosis.

Garlic has been touted as good for everything from worms to vampires. According to Fulder, the 1,000 papers on garlic, which have appeared in the international scientific literature, prove, without doubt, that garlic will:

TREAT INFECTIONS. Garlic is effective against colds, cystitis, or other infections of the mouth, skin, ears or throat, and ithas the ability to act as a broad spectrum antibiotic. It is also effective against fungi and candida albicans. "According to studies at the Department of Microbiology at the University of Oklahoma, garlic juice is as strong as the antifungal drugs amphotericin and nystatin, and certainly safer. Half an hour after eating a high dose of fresh garlic your blood itself can kill fungi," Fulder writes.

PROTECT THE CIRCULATIONMany studies, including those in the Lancet, show that garlic taken over a few months can reduce the level of cholesterol in the blood by 15 per cent and heart attack risk by 30 per cent. It also thinks the blood, reducing the risk of thrombosis. Just a half a clove of garlic will reduce the stickiness in the blood.

PROTECT YOU AGAINST TOXIC SUBSTANCES. Many American centres, including New York University's School of Medicine concluded that garlic can help prevent cancer by preventing carcinogens from causing harm. It can also clean out heavy metals and drugs.

Besides crushed fresh garlic (the best way to take garlic), Fulder advises that the sulphur compounds in garlic (called allicin) are what fights infection and thins the blood. This means that, in order to work, the garlic that you take has to be odorous. Fulder recommends that whole garlic in dry form is the best acting (rather than garlic oil capsules or aged garlic in alcohol).

With dried garlic, the garlic is crushed then dried with heat or cool dried into powder. You should also look to products with no fillers or additives (other than something like citrus oil).

One glove of garlic usually reduces into one gm of dried powder. Those attempting to treat a condition are best taking two to three gms per day, he says that is, the equivalent of three cloves a day. For simple prevention, one to two cloves or their equivalent is enough.

Elective by force

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