Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation

Objectives: To establish a uniform anticoagulation regimen for pregnant patients with mechanical heart valves taking into account the socio-economic background and to evaluate the incidence of anticoagulant related complications. Methods: A retrospective study on 63 pregnancies in 21 women with mech...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2002-08, Vol.22 (2), p.223-227
Main Authors: Al-Lawati, Adil A.M., Venkitraman, M., Al-Delaime, Taha, Valliathu, John
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Anticoagulants - administration & dosage
Anticoagulation
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Coumarin embryopathy
Coumarins - administration & dosage
Drug Administration Schedule
Female
Heart Valve Prosthesis
Heparin - administration & dosage
Humans
Injections, Subcutaneous
Low molecular weight heparin
Mechanical heart valves
Medical sciences
Pharmacology. Drug treatments
Pregnancy
Pregnancy Complications, Cardiovascular - drug therapy
Pregnancy Outcome
Retrospective Studies
Risk Factors
Thrombosis - epidemiology
Thrombosis - prevention & control
Treatment Outcome
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Summary:Objectives: To establish a uniform anticoagulation regimen for pregnant patients with mechanical heart valves taking into account the socio-economic background and to evaluate the incidence of anticoagulant related complications. Methods: A retrospective study on 63 pregnancies in 21 women with mechanical heart valves was evaluated. These pregnancies were divided into two groups: Group I (n=42) received oral anticoagulants throughout pregnancy and Group II (n=21) received subcutaneous heparin in the 1st trimester and oral anticoagulants for the rest of pregnancy period. Both groups received heparin at time of delivery. Results: There was no case of coumarin embryopathy seen and there was no maternal death. Life threatening valve thrombosis occurred in two patients who were both from Group II and needed emergency re-replacement. Group I had a higher incidence of spontaneous abortion than Group II although this was not statistically significant. Conclusions: The role of coumarin embryopathy has been overstated. We recommend the use of oral anticoagulants throughout pregnancy especially in countries with similar socio-economic background.
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(02)00302-0