Anticoagulation therapy in pregnant women with mechanical heart valve.

Abstract

BACKGROUND:

This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen.

METHODS:

Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy.

RESULTS:

Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded.

CONCLUSION:

Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ≤5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman.

• Authors: Hakkı Zafer İşcan, Muhammet Onur Hanedan, Anıl Özen, Adem Diken, Veysel Başar, Ertekin Utku Ünal, Cemal Levent Birincioğlu
• Journal: Turk gogus kalp damar cerrahisi dergisi (Turk Gogus Kalp Damar Cerrahisi Derg) Vol. 26 Issue 1 Pg. 38-44 (Jan 2018) ISSN: 1301-5680 [Print] Turkey
• PMID: 32082709 (Publication Type: Journal Article)
• Copyright: Copyright © 2018, Turkish Society of Cardiovascular Surgery.