Anticoagulation in Pregnant Women with a Bileaflet Mechanical Cardiac Valve Replacement

Authors

  • Kyung-Hwan Kim
  • Dong Seop Jeong
  • Hyuk Ahn

DOI:

https://doi.org/10.1532/HSF98.20071024

Abstract

Background. We investigated the risk and outcome of anticoagulation in pregnant women who had a mechanical valve.

Materials and Methods. This retrospective study was undertaken for 41 pregnancies (27 women, 33.1 ± 4.7 years old) from January 1990 to December 2005. Patients were divided into 3 groups: group I (n = 5) took warfarin throughout the pregnancy, group II (n = 18) took heparin throughout the pregnancy, and group III (n = 18) took heparin in the 1st trimester and warfarin from a gestational age of 12 to 20 weeks.

Results. Twenty-three pregnancies (56.1%) resulted in live births, 11 (26.8%) in stillbirths, and 8 (19.5%) in spontaneous abortions (SA). In group I, there were 2 live births (40.0%), 2 stillbirths (40.0%), and 1 SA (20.0%); in group II, there were 10 live births (55.6%), 1 stillbirth (5.6%), and 7 SA (38.9%); and in group III, there were 10 live births (55.6%), 8 stillbirths (44.4%), and no SA. No significant difference was observed between the 3 groups in terms of successful delivery rates (P = .826).

Conclusion. The probability of successful delivery was low. No single reliable anticoagulation protocol in pregnant patients with mechanical valves emerged from the collated data.

References

Al-Lawati AM, Venkitraman M, Al-Delaime T, Valliathu J. 2002. Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation. Eur J Cardiothorac Surg22:223-7.nBerndt N, Khan I, Gallo R. 2000. A complication in anticoagulation using low-molecular weight heparin in a patient with mechanical valve prosthesis. A case report. J Heart Valve Dis9:844-6.nChan WS. 1999. What is the optimal management of pregnant women with valvular heart disease in pregnancy? Hemostasis29(suppl 1):105-6.nChan WS. 2000. Anticoagulation of pregnant women with mechanical heart valves: a systematic review. Arch Intern Med160:191-6.nChoi SH, Ko KP, Han JO, Chui JB, Kim GH. 2000. Anticoagulation therapy in pregnant women with mechanical cardiac valve prosthesis. Korean J Thorac Cardiovasc Surg33:502-6.nConti RC. 2003. Anticoagulation for mechanical valve prostheses during pregnancy. Clin Cardiol26:303-4.nDahlman T, Lindvall N, Hellgren M. 1990. Osteopenia in pregnancy during long-term heparin treatment: a radiological study postpartum. Br J Obstet Gynadecol97:221-8.nEdmunds Jr HL, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. 1996. Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg62:932-5.nElkayam UR. 1996. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol27:1704-6.nGinsberg JS, Hirsh J, Turner DC, Levine MN, Burrows R. 1989. Risks to the fetus of anticoagulant therapy during pregnancy. Thromb Haemost61:197-203.nGinsberg JS, Kowalchuk G, Hirsh J, Brill Edwards P, Burrows R. 1989. Heparin therapy during pregnancy: risks to the fetus and mother. Arch Intern Med149:2233-6.nHall JG, Pauli RM, Wilson KM. 1980. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med68:122-140.nHirsh J. 1991. Oral anticoagulant drugs. N Engl J Med324:1865-75.nIan AG. 2006. Anticoagulation in pregnancy. J Thromb Thrombolysis21:57-65.nIturbe-Alessio I, Fonseca MC, Mutchinik O, Santos MA, Zajarias A, Salazar E. 1986. Risks of anticoagulant therapy in pregnant women with artificial heart valves. N Engl J Med315:1390-93.nLee SY, Jang BC, Park HG, et al. 1999. Pregnancy in patients with prosthetic heart valve. Korean J Thorac Cardiovasc Surg32:1023-30.nLev-Ran O, Kramer A, Gurevitch J, Shapira I, Mohr R. 2000. Low- molecular-weight heparin for prosthetic heart valves: treatment failure. Ann Thorac Surg69:264-5.nNelson-Percy C, Letsky EA, de Swiet M. 1997. Low molecular weight heparin for obstetric thromboprophylaxis: experience of 69 pregnancies in 61 women at high risk. Am J Obstet Gynecol176:1062-8.nRainer GL, Stefan F, Arjang R, Axel H. 2002. Anticoagulation for prosthetic heart valves during pregnancy: is low-molecular weight heparin an alternative? Eur J Cardiothorac Surg21:577-9.nSalazar E, Iziguirre R, Verdego J, Mutchinick O. 1996. Failure of adjusted doses of subcutaneous heparin to prevent thromboembolic phenomena in pregnant patients with mechanical cardiac valve prostheses. J Am Coll Cardiol27:1698-1703.nSareli P, England MJ, Berk MR, et al. 1989. Maternal and fetal sequelae of anticoagulation during pregnancy in patients with mechanical heart valve prostheses. Am J Cardiol63:1462-5.nSbarouni E, Oakley CM. 1994. Outcome of pregnancy in women with valve prosthesis. Br Heart J71:196-201.nVitale N, De Feo M, De Santo LS, Pollice A, Tedesso N, Cotrufo M. 1999. Dose-dependent fetal complications of warfarin in pregnant women with mechanical valves. J Am Coll Cardiol33:1637-41.n

Published

2007-06-04

How to Cite

Kim, K.-H., Jeong, D. S., & Ahn, H. (2007). Anticoagulation in Pregnant Women with a Bileaflet Mechanical Cardiac Valve Replacement. The Heart Surgery Forum, 10(4), E267-E270. https://doi.org/10.1532/HSF98.20071024

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