Valvular heart diseaseUse of Low Molecular Weight Heparin in Pregnant Women With Mechanical Heart Valves
Section snippets
Methods
This was a substudy of a larger prospective cohort study of pregnant women with heart disease. Women enrolled in our ongoing study were included in this study if they (1) completed pregnancies from January 1998 to December 2008, (2) had mechanical mitral or aortic prosthetic valves, and (3) were treated with LMWH at our center throughout their pregnancies. Women with mechanical valves who presented late in pregnancy and therefore did not have anticoagulation therapy initiated and monitored at
Results
From 1998 to 2008, 870 pregnancies in women with heart disease were prospectively followed at our center. Of these, 23 pregnancies occurred in 17 women with mechanical mitral or aortic valves who were treated with LMWH throughout pregnancy. Of the 23 pregnancies, there were 19 live births, 2 first-trimester miscarriages, and 2 intrauterine fetal deaths. The underlying cardiac diagnoses included rheumatic heart disease (n = 11), endocarditis (n = 1), and congenital heart disease (n = 11). The
Discussion
There are few data regarding the efficacy and safety of LMWH in pregnant women with mechanical heart valves. We studied the outcomes of women with mechanical prosthetic heart valves who were treated with LMWH and aspirin throughout gestation. Carefully monitored LMWH may be a suitable anticoagulation strategy in pregnant women with mechanical heart valves who are unwilling to use warfarin. However, maternal cardiac and fetal complications were high in this group of women, and bleeding
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Cited by (110)
Society for Maternal-Fetal Medicine Consult Series #61: Anticoagulation in pregnant patients with cardiac disease
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2022, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
2021, Journal of Thoracic and Cardiovascular Surgery2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
2021, Journal of the American College of CardiologyBiological versus mechanical heart valve prosthesis during pregnancy in women with congenital heart disease
2018, International Journal of CardiologyCitation Excerpt :This may be related to LMWH therapy; when LMWH is used during pregnancy, the dose needs to be increased due to an increased glomerular filtration rate and renal clearance of LMWH. Therefore, current guidelines recommend that LMWH is only used in women with mechanical PHV when close monitoring of anti-Xa levels is performed [6,7,11,12,14,28]. The optimal range of anti-Xa levels, whether to measure peak or through levels and interval of measurements is still debated [6,11–13].
This study was supported by Operating Grants 53130 and 93722 from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada; and Grants NA5662 and NA5927 from the Heart and Stroke Foundation of Canada, Ottawa, Ontario, Canada. Dr. Siu is supported by the Ramsay Gunton Professorship. The authors also acknowledge generous program support from Josephine Rogers.