Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience.

Abstract

OBJECTIVE:

This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens.

STUDY DESIGN:

A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome.

RESULTS:

The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage.

CONCLUSION:

No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.

• Authors: Vanita Suri, Anish Keepanasseril, Neelam Aggarwal, Seema Chopra, Rashmi Bagga, Pooja Sikka, Rajesh Vijayvergiya
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 159 Issue 2 Pg. 320-3 (Dec 2011) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 21962462 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anticoagulants
• Warfarin
• Heparin
• Acenocoumarol

Topics

• Abortion, Spontaneous (etiology)
• Academic Medical Centers
• Acenocoumarol (adverse effects, therapeutic use)
• Adult
• Anticoagulants (adverse effects, therapeutic use)
• Female
• Heart Valve Diseases (surgery)
• Heart Valve Prosthesis (adverse effects)
• Heparin (adverse effects, therapeutic use)
• Humans
• Incidence
• India (epidemiology)
• Medical Records
• Mitral Valve (surgery)
• Postpartum Hemorrhage (etiology)
• Pregnancy
• Pregnancy Complications (etiology, prevention & control)
• Pregnancy Complications, Cardiovascular (surgery)
• Pregnancy Complications, Hematologic (etiology, prevention & control)
• Pregnancy Outcome
• Retrospective Studies
• Thrombosis (etiology, prevention & control)
• Warfarin (adverse effects, therapeutic use)
• Young Adult