Low‐molecular‐weight heparin or warfarin for anticoagulation in pregnant women with mechanical heart valves: what are the risks? A retrospective observational study

Abstract

The management of anticoagulation in pregnant women with mechanical heart valves is complex. The maternal and fetal outcomes of 32 pregnancies in 15 women on three different anticoagulation regimens were compared. Anticoagulation with low-molecular-weight heparin (n = 4), warfarin (n = 22) and combination therapy (n = 6) resulted in adverse maternal events in four (100%), three (50%) and three (14%) women, and resulted in fetal losses in one (25%), 17(77%) and three (50%) pregnancies, respectively. Whereas the rate of fetal loss in the warfarin group was high, all women in the LMWH and half of those in the combination group had serious adverse maternal events, including valve thrombosis, maternal death and postpartum haemorrhage.

Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta‐analysis

“…Infants of these women are at an increased risk of perinatal mortality, preterm birth, smallfor-gestational-age (SGA) and congenital malformations. [6][7][8][9][10][11][12] The design of prosthetic heart valves continues to improve. The highly thrombogenic ball-and-cage style valves have been virtually eradicated by the newer design bi-leaflet valves, lowering anticoagulant requirements.…”

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…Fetal and neonatal risks include fetal loss, still births, preterm births, growth restriction, and prematurity. [134][135][136][137][138][139][140][141][142][143][144][145][146][147][148] The rates of complications vary in relation to the woman's underlying cardiac condition, the function and location of the mechanical valve, and the type of anticoagulation used during pregnancy. Because of the high-risk nature of these pregnancies, all women should be seen for preconception counseling by a cardiologist with expertise in pregnancy and valve disease.…”

Clinical outcomes of pregnant women with mechanical heart valves

“…[22] DMAH tedavisinin sadece pik anti-Xa seviyesinin (enjeksiyondan 4 saat sonra) ölçümü ile monitörizasyonunun yetersiz olabileceğini bildirmişlerdir. Basude ve ark., [23] 15 hastada 32 gebeliği retrospektif olarak incelemiş, dört hastaya DMAH, 22 hastaya varfarin ve altı hastaya kombinasyon tedavisi uygulayarak takip etmişler ve DMAH uygulanan tüm hastalar ile kombinasyon tedavisi uygulanan hastaların yarısında, kapak trombozu, maternal ölüm ve postpartum hemorajiyi içeren ciddi aksi maternal olaylar geliştiğini bildirmişlerdir. Yakın anti-Xa takibi ile iyi sonuçlar bildiren çalışmalar [24] var olmasına rağmen, DMAH'lerin bu hastalarda güvenilirliğiyle ilgili daha fazla bilimsel kanıta ihtiyaç vardır.…”