Anticoagulation of women with congenital heart disease during pregnancy

• Published in: International journal of cardiology congenital heart disease 2021-10, Vol.5, p.100210, Article 100210
• Main Authors: Rutz, Tobias, Eggel-Hort, Béatrice, Alberio, Lorenzo, Bouchardy, Judith
• Format: Article
• Language: English
• Subjects: Anticoagulation; Congenital heart disease; Low molecular weight heparin; Mechanical heart valve prosthesis; Pregnancy; Vitamin K antagonist
• ISSN: 2666-6685; 2666-6685
• DOI: 10.1016/j.ijcchd.2021.100210

Outcome of patients with congenital heart disease (CHD) has significantly improved over the last 40 years and most patients survive into adulthood. A considerable number of women with repaired and non-repaired CHD lesions reach the age of procreation. These patients encounter more frequently maternal and fetal complications during pregnancy than the general population. Pregnant patients with CHD are not only at a particularly elevated risk for thromboembolic events but also present a high predisposition for bleeding complications. Anticoagulation treatment during pregnancy with vitamin K antagonists (VKA) and low molecular weight heparin- (LMWH) significantly increases the already important risk for maternal and fetal adverse events in these women. Patients after mechanical heart valve prosthesis implantation are at highest risk. This article reviews the specific cardiac, obstetric and hemostasiologic aspects of pregnant women with CHD and anticoagulation treatment, and provides suggestions for the follow-up and possible anticoagulation strategies during pregnancy.