Key result
The use of fixed-dose low molecular weight heparin without anti-Xa monitoring during pregnancy in women with mechanical heart valves led to severe valve thrombosis in three cases.
Case Report (n=3)
No
The use of fixed-dose LMWH without anti-Xa monitoring in pregnant women with mechanical heart valves poses a significant risk for life-threatening valve thrombosis.
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Unmonitored fixed-dose LMWH may risk valve thrombosis in pregnant mechanical-valve patients; leaves open optimal regimens for prospective trials.
Pregnancy is associated with an increased risk of valve thrombosis, hemorrhagic complications, and offspring complications in patients with metallic prosthetic heart valve (MHV). Warfarin treatment is the best regimen against thromboembolic complications, but its use in the first trimester can result in embryopathy. Low molecular weight heparin (LMWH) does not cross the placenta and has some potential advantages. However, the pharmacokinetics of LMWHs change during pregnancy, and serial monitoring of anti-Xa levels is strongly recommended. Despite this recommendation, LMWH therapy in a fixed dose is still used in pregnant women with MHV without monitoring anti-Xa activity in clinical practice. We present three cases of MHV thrombosis occurring while on therapy with LMWH during pregnancy. One of these patients showed cerebrovascular event, one presented with pulmonary edema, and one underwent reoperation for MHV thrombosis.
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Utku Şenol (2014) conducted a case report in Pregnancy with mechanical heart valves (n=3). Low molecular weight heparin (enoxaparin) was evaluated on Valve thrombosis and thromboembolic complications. The use of fixed-dose low molecular weight heparin without anti-Xa monitoring during pregnancy in women with mechanical heart valves led to severe valve thrombosis in three cases.
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