Abstract
Objective
This study was undertaken to analyze the maternal and perinatal outcome in women with
prosthetic heart valves on different anticoagulant regimens.
Study design
A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses
at a tertiary referral centre from 1997 to 2010. The main outcome measures were major
maternal complications and perinatal outcome.
Results
The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine
pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%)
had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth
rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%).
There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol
in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin
in the postpartum period, 2 of whom required transfusion. In addition one patient
who was on acenocoumarol developed secondary hemorrhage.
Conclusion
No anticoagulant regimen can be said to be entirely safe for use during pregnancy
as there is a degree of risk with each regimen. Further larger studies are needed
to come up with sufficient evidence-based recommendations for the best possible management
of such patients to reduce the maternal risks after mechanical heart valve replacement
without compromising fetal outcome.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The hypercoagulable states.Ann Intern Med. 1985; 102: 814-828
- Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves.J Am Coll Cardiol. 1999; 33: 1637-1641
- Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature.Arch Intern Med. 2000; 160: 191-196
- Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves.BJOG. 2000; 107: 245-253
- Management of anticoagulants during pregnancy.Heart. 2001; 86: 125-126
- Heparin-induced thrombocytopenia.Circulation. 2006; 22: e355-e356
- Safety of lovenox in pregnancy.ACOG, Washington, DC2002 (ACOG Committee Opinion 276)
- Enoxaparin treatment in women with mechanical heart valves during pregnancy.Am J Obstet Gynecol. 2001; 185: 633-637
- Maternal and fetal sequelae and anticoagulation during pregnancy.Am J Med. 1980; 68: 122-140
- Use of antithrombotic agents during pregnancy.Chest. 1998; 114: 524S-530S
- Pregnancy outcome in women with prosthetic heart valves.AJOG. 2004; 191: 1009-1013
- The relationship between maintenance dosages of three vitamin K antagonists: acenocoumarol, warfarin and phenprocoumon.Thromb Res. 2008; 123: 225-230
- Anticoagulation for prosthetic heart valves in pregnancy. Is there an answer?.Asian Cardiovasc Thorac Ann. 2007; 15: 493-496
- Outcome of pregnancy in women with valve prostheses.Br Heart J. 1994; 71: 196-201
Article info
Publication history
Published online: September 19, 2011
Accepted:
September 1,
2011
Received in revised form:
July 15,
2011
Received:
May 22,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
