Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With Mechanical Heart Valves

Abstract

BackgroundAnticoagulation for mechanical heart valves during pregnancy is essential to prevent thromboembolic events. Each regimen has drawbacks with regard to maternal or fetal risk.ObjectivesThis meta-analysis sought to estimate and compare the risk of adverse maternal and fetal outcomes in pregnant women with mechanical heart valves who received different methods of anticoagulation.MethodsStudies were identified using a Medline search including all publications up to June 5, 2016. Study inclusion required reporting of maternal death, thromboembolism, and valve failure, and/or fetal spontaneous abortion, death, and congenital defects in pregnant women treated with any of the following: 1) a vitamin K antagonist (VKA) throughout pregnancy; 2) low-molecular-weight heparin (LMWH) throughout pregnancy; 3) LMWH for the first trimester, followed by a VKA (LMWH and VKA); or 4) unfractionated heparin for the first trimester, followed by a VKA (UFH and VKA).ResultsA total of 800 pregnancies from 18 publications were included. Composite maternal risk was lowest with VKA (5%), compared with LMWH (16%; ratio of averaged risk [RAR]: 3.2; 95% confidence interval [CI]: 1.5 to 7.5), LMWH and VKA (16%; RAR: 3.1; 95% CI: 1.2 to 7.5), or UFH and VKA (16%; RAR: 3.1; 95% CI: 1.5 to 7.1). Composite fetal risk was lowest with LMWH (13%; RAR: 0.3; 95% CI: 0.1 to 0.8), compared with VKA (39%), LMWH and VKA (23%), or UFH and VKA (34%). No significant difference in fetal risk was observed between women taking ≤5 mg daily warfarin and those with an LMWH regimen (RAR: 0.9; 95% CI: 0.3 to 2.4).ConclusionsVKA treatment was associated with the lowest risk of adverse maternal outcomes, whereas the use of LMWH throughout pregnancy was associated with the lowest risk of adverse fetal outcomes. Fetal risk was similar between women taking ≤5 mg warfarin daily and women treated with LMWH.

WITHDRAWN: A multicenter case-control study on non-genetic risk factors in infants with congenital heart disease

“…24 The intake of hormones during pregnancy increased the risk of CHD in the fetus, such as intake of progesterone in the early pregnancy and ventricular septal defect in the offspring had over 5times higher risk of developing CHD than those in the control group. 25 Early use of erythromycins, non-steroidal anti-inflammatory drugs and drugs for thyroid diseases in pregnant women would lead to CHD in their offspring. 26 This study showed that drug use in early pregnancy is a more sensitive teratogenic factor than other factors among various analysis factors.…”

Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

“…The high risk of anticoagulation in pregnancy requires better reporting in any study of women with RHD. A recent meta‐analysis of anticoagulation in women with mechanical heart valves found fetal risk was similar between women taking <5 mg warfarin daily to those on low molecular weight heparin . These findings underscore the need for granularity of reporting prescribed regimens—including level of adherence and women's access to treatment.…”

Valve sparing aortic root replacement (David Procedure) in 36 year - old woman with the Marfan syndrome at the 27th week of pregnancy

“…Эта методика, ее модификации хорошо зарекомендовали себя и в нашей клинике, дают положительные результаты в отдаленные сроки [13,14]. Однако такой методике могут сопутствовать осложнения, ассоциированные с наличием механического протеза клапана [15]. Кроме того, методика Бенталла-Де Боно предусматривает последующую необходимость антикоагулянтной терапии препаратами кумаринового ряда, проникающими через фетоплацентарный барьер и вызывающими у плода синдром «варфариновой эмбриопатии», а также фатальные геморрагические осложнения [16].…”