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Heart 1999;82:23-26; doi:10.1136/hrt.82.1.23
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 1999;82:23-26 ( July )

Anticoagulation in pregnant women with mechanical heart valve prostheses

S S Meschengieser, C G Fondevila, M T Santarelli, M A Lazzari

Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematológicas "Mariano R Castex", Academia Nacional de Medicina, Buenos Aires, Argentina

Correspondence to: Dr S S Meschengieser, Pacheco de Melo 3081, 1425 Buenos Aires, Argentina.

Accepted for publication 26 January 1999

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

© 1999 by Heart
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