From the Guidelines
Atrial myxoma patients on Lovenox due to pregnancy should continue treatment throughout pregnancy and for at least 6 weeks postpartum, with dosage adjustments based on anti-Xa levels monitored every 1-3 months, as recommended by the European Society of Cardiology guidelines 1. The management of atrial myxoma during pregnancy is crucial to prevent complications such as stroke or cardiac obstruction.
- The use of Lovenox (enoxaparin) is preferred over warfarin due to its safety profile during pregnancy, as warfarin can cross the placenta and cause birth defects 1.
- The dosage of Lovenox is typically weight-based, often 1 mg/kg twice daily or 1.5 mg/kg once daily administered subcutaneously, and should be adjusted based on anti-Xa levels monitored every 1-3 months 1.
- Close monitoring by both a cardiologist and high-risk obstetrician is essential to manage the condition and prevent complications.
- Regular echocardiograms should be performed to monitor tumor size and cardiac function throughout pregnancy, and surgical removal of the myxoma may be considered if it is large or causing significant symptoms, although this is typically deferred until after delivery when possible 1.
- The European Society of Cardiology guidelines recommend that patients with atrial myxoma should be managed by a multidisciplinary team, including cardiologists, obstetricians, and anesthesiologists, to ensure optimal care during pregnancy and postpartum 1.
From the Research
Atrial Myxoma and Pregnancy
- Atrial myxoma is a rare condition, and its incidence during pregnancy is extremely low 2.
- The management of atrial myxoma during pregnancy is often based on anecdotal experiences due to the rarity of these cases 2.
- In a case study, a woman with atrial myxoma at 32nd gestational week was managed with corticosteroid prophylaxis to reduce neonatal complications, and cesarean delivery and surgical resection of the myxoma were delayed 2.
Treatment with Lovenox (Enoxaparin)
- There is limited information on the use of Lovenox (enoxaparin) in patients with atrial myxoma during pregnancy.
- A study on anti-factor Xa monitoring of enoxaparin thromboembolism prophylaxis in emergency general surgery patients found that standard dose VTE prophylaxis regimens may provide inadequate VTE prophylaxis 3.
- The study suggests that ongoing anti-factor Xa monitoring and adjustment of dosing may be necessary to ensure adequate VTE prophylaxis 3.
Clinical Presentation and Diagnosis
- Atrial myxomas are the most common type of primary cardiac tumors in adults, and they can present with various symptoms, including constitutional, embolic, and obstructive or cardiac symptoms 4, 5.
- The diagnosis of atrial myxoma can be established based on clinical, imaging, and histopathology features, and echocardiogram is the first-line imaging technique 5.
- However, echocardiogram may be fallible, and other imaging modalities such as CT scan or cardiac MRI may be necessary to confirm the diagnosis 5.