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. 1999 Jul;82(1):23–26. doi: 10.1136/hrt.82.1.23

Anticoagulation in pregnant women with mechanical heart valve prostheses

S Meschengieser 1, C Fondevila 1, M Santarelli 1, M Lazzari 1
PMCID: PMC1729094  PMID: 10377303

Abstract

OBJECTIVE—To evaluate the outcome of pregnancy in women with mechanical heart valve prostheses in relation to the anticoagulant treatment used in the first trimester and the incidence of thrombotic and bleeding complications.
METHODS—92 pregnancies in 59 women were followed between 1986 and 1997. In 31 pregnancies, oral anticoagulants were discontinued when pregnancy was diagnosed and subcutaneous heparin was started (12 500 U every 12 hours) adjusted to prolong the adjusted partial thromboplastin time to twice the control level. In the second trimester oral anticoagulants were resumed but changed to heparin again 15 days before the expected delivery date. In 61 pregnancies oral anticoagulants were continued during the first trimester. The same regimen of heparin was used for delivery.
RESULTS—Abortion or fetal losses were similar (p = 0.5717) in women exposed to oral anticoagulants in the first trimester (13/61; 25%) compared with those who received adjusted subcutaneous heparin (6/31; 19%). Embolic episodes were more common (p = 0.0029) in women who received heparin (4.92%) compared with those on oral anticoagulants (0.33%). Embolic episodes were cerebral and transient. No valve thromboses were observed. No malformations appeared in the 71 newborns, except for one case of hydrocephalus. There were no maternal deaths secondary to thrombotic complications. The only death was the result of major bleeding after the delivery of a premature stillborn.
CONCLUSIONS—Oral anticoagulants seem to be safer for the mother than adjusted subcutaneous heparin. Heparin does not offer a clear advantage over oral anticoagulation in the pregnancy outcome.


Keywords: pregnancy; oral anticoagulants; heparin; prosthetic valves

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Selected References

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  1. Ben Ismail M., Abid F., Trabelsi S., Taktak M., Fekih M. Cardiac valve prostheses, anticoagulation, and pregnancy. Br Heart J. 1986 Jan;55(1):101–105. doi: 10.1136/hrt.55.1.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Born D., Martinez E. E., Almeida P. A., Santos D. V., Carvalho A. C., Moron A. F., Miyasaki C. H., Moraes S. D., Ambrose J. A. Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate. Am Heart J. 1992 Aug;124(2):413–417. doi: 10.1016/0002-8703(92)90606-v. [DOI] [PubMed] [Google Scholar]
  3. Chen W. W., Chan C. S., Lee P. K., Wang R. Y., Wong V. C. Pregnancy in patients with prosthetic heart valves: an experience with 45 pregnancies. Q J Med. 1982 Summer;51(203):358–365. [PubMed] [Google Scholar]
  4. Cotrufo M., de Luca T. S., Calabrò R., Mastrogiovanni G., Lama D. Coumarin anticoagulation during pregnancy in patients with mechanical valve prostheses. Eur J Cardiothorac Surg. 1991;5(6):300–305. doi: 10.1016/1010-7940(91)90039-m. [DOI] [PubMed] [Google Scholar]
  5. Ginsberg J. S., Hirsh J., Turner D. C., Levine M. N., Burrows R. Risks to the fetus of anticoagulant therapy during pregnancy. Thromb Haemost. 1989 Apr 25;61(2):197–203. [PubMed] [Google Scholar]
  6. Hall J. G., Pauli R. M., Wilson K. M. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med. 1980 Jan;68(1):122–140. doi: 10.1016/0002-9343(80)90181-3. [DOI] [PubMed] [Google Scholar]
  7. Hanson D., Winterbauer R. H., Kirtland S. H., Wu R. Changes in pulmonary function test results after 1 year of therapy as predictors of survival in patients with idiopathic pulmonary fibrosis. Chest. 1995 Aug;108(2):305–310. doi: 10.1378/chest.108.2.305. [DOI] [PubMed] [Google Scholar]
  8. Iturbe-Alessio I., Fonseca M. C., Mutchinik O., Santos M. A., Zajarías A., Salazar E. Risks of anticoagulant therapy in pregnant women with artificial heart valves. N Engl J Med. 1986 Nov 27;315(22):1390–1393. doi: 10.1056/NEJM198611273152205. [DOI] [PubMed] [Google Scholar]
  9. Larrea J. L., Núez L., Reque J. A., Gil Aguado M., Matarros R., Minguez J. A. Pregnancy and mechanical valve prostheses: a high-risk situation for the mother and the fetus. Ann Thorac Surg. 1983 Oct;36(4):459–463. doi: 10.1016/s0003-4975(10)60488-2. [DOI] [PubMed] [Google Scholar]
  10. Lee L. H., Liauw P. C., Ng A. S. Low molecular weight heparin for thromboprophylaxis during pregnancy in 2 patients with mechanical mitral valve replacement. Thromb Haemost. 1996 Oct;76(4):628–630. [PubMed] [Google Scholar]
  11. Lee P. K., Wang R. Y., Chow J. S., Cheung K. L., Wong V. C., Chan T. K. Combined use of warfarin and adjusted subcutaneous heparin during pregnancy in patients with an artificial heart valve. J Am Coll Cardiol. 1986 Jul;8(1):221–224. doi: 10.1016/s0735-1097(86)80116-4. [DOI] [PubMed] [Google Scholar]
  12. Meschengieser S. S., Fondevila C. G., Frontroth J., Santarelli M. T., Lazzari M. A. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg. 1997 May;113(5):910–916. doi: 10.1016/S0022-5223(97)70264-2. [DOI] [PubMed] [Google Scholar]
  13. Oakley C. M. Anticoagulants in pregnancy. Br Heart J. 1995 Aug;74(2):107–111. doi: 10.1136/hrt.74.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Palacios-Macedo X., Díaz-Devis C., Escudero J. Fetal risk with the use of coumarin anticoagulant agents in pregnant patients with intracardiac ball valve prosthesis. Am J Cardiol. 1969 Dec;24(6):853–856. doi: 10.1016/0002-9149(69)90475-5. [DOI] [PubMed] [Google Scholar]
  15. Pavankumar P., Venugopal P., Kaul U., Iyer K. S., Das B., Sampathkumar A., Airon B., Rao I. M., Sharma M. L., Bhatia M. L. Pregnancy in patients with prosthetic cardiac valve. A 10-year experience. Scand J Thorac Cardiovasc Surg. 1988;22(1):19–22. doi: 10.3109/14017438809106045. [DOI] [PubMed] [Google Scholar]
  16. Salazar E., Izaguirre R., Verdejo J., Mutchinick O. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol. 1996 Jun;27(7):1698–1703. doi: 10.1016/0735-1097(96)00072-1. [DOI] [PubMed] [Google Scholar]
  17. Sareli P., England M. J., Berk M. R., Marcus R. H., Epstein M., Driscoll J., Meyer T., McIntyre J., van Gelderen C. Maternal and fetal sequelae of anticoagulation during pregnancy in patients with mechanical heart valve prostheses. Am J Cardiol. 1989 Jun 15;63(20):1462–1465. doi: 10.1016/0002-9149(89)90008-8. [DOI] [PubMed] [Google Scholar]
  18. Sbarouni E., Oakley C. M. Outcome of pregnancy in women with valve prostheses. Br Heart J. 1994 Feb;71(2):196–201. doi: 10.1136/hrt.71.2.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Stevenson R. E., Burton O. M., Ferlauto G. J., Taylor H. A. Hazards of oral anticoagulants during pregnancy. JAMA. 1980 Apr 18;243(15):1549–1551. [PubMed] [Google Scholar]

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