Anticoagulation during pregnancy in women with congenital heart disease requires balancing maternal thromboembolic risks against fetal adverse events, with VKA regimens generally protecting the mother and LMWH regimens protecting the fetus.
Managing anticoagulation in pregnant women with congenital heart disease requires balancing maternal thromboembolic risks against fetal bleeding and teratogenic risks through multidisciplinary care.
Outcome of patients with congenital heart disease (CHD) has significantly improved over the last 40 years and most patients survive into adulthood. A considerable number of women with repaired and non-repaired CHD lesions reach the age of procreation. These patients encounter more frequently maternal and fetal complications during pregnancy than the general population. Pregnant patients with CHD are not only at a particularly elevated risk for thromboembolic events but also present a high predisposition for bleeding complications. Anticoagulation treatment during pregnancy with vitamin K antagonists (VKA) and low molecular weight heparin- (LMWH) significantly increases the already important risk for maternal and fetal adverse events in these women. Patients after mechanical heart valve prosthesis implantation are at highest risk. This article reviews the specific cardiac, obstetric and hemostasiologic aspects of pregnant women with CHD and anticoagulation treatment, and provides suggestions for the follow-up and possible anticoagulation strategies during pregnancy.
Rutz et al. (Wed,) conducted a review in Congenital heart disease in pregnancy. Anticoagulation was evaluated. Anticoagulation during pregnancy in women with congenital heart disease requires balancing maternal thromboembolic risks against fetal adverse events, with VKA regimens generally protecting the mother and LMWH regimens protecting the fetus.