Key result
Unfractionated heparin therapy during pregnancy after mechanical valve replacement was associated with a high rate of maternal complications, including valve thrombosis and intracranial hemorrhage in 4 of 9 pregnancies.
Why the study?
Is unfractionated heparin therapy safe and effective for anticoagulation during pregnancy in women with mechanical valve replacement?
Observational (n=9)
No
Is unfractionated heparin therapy safe and effective for anticoagulation during pregnancy in women with mechanical valve replacement?
Unfractionated heparin therapy during pregnancy in women with mechanical heart valves is associated with a high rate of severe maternal and neonatal complications.
Answers are grounded in this paper and cite their sources.
May warrant caution with unfractionated heparin in pregnant women with mechanical valves; leaves open need for optimized regimens in prospective studies.
BACKGROUND: Consensus has not been reached about the anticoagulant therapy to be used during pregnancy after mechanical valve replacement. Warfarin is a fetal toxicant, so we retrospectively examined anticoagulant therapy using unfractionated heparin. METHODS AND RESULTS: Pregnancy after mechanical valve replacement occurred in 25 cases between 1983 and 2011. Targeted therapy using unfractionated heparin was administered in 9 pregnancies, which were divided into 3 groups: Group I received subcutaneous administration of heparin and APTT was measured twice weekly; Group II received heparin by constant rate infusion (CRI) and APTT was measured twice weekly; Group III received CRI of heparin and APTT was measured daily. Maternal complications consisted of valve thrombosis and perinatal bleeding in 1 pregnancy (Group I), intracranial hemorrhage in 2 pregnancies (Group II), and valve thrombosis and perinatal bleeding in 1 pregnancy (Group III). Two infants died in the neonatal period. CONCLUSIONS: Each group showed a high rate of maternal complications, so a review of current anticoagulant treatment strategies is necessary.
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Tanaka et al. (2014) conducted an observational in Pregnancy after mechanical valve replacement (n=9). Unfractionated heparin was evaluated on Maternal complications (valve thrombosis, intracranial hemorrhage, perinatal bleeding). Unfractionated heparin therapy during pregnancy after mechanical valve replacement was associated with a high rate of maternal complications, including valve thrombosis and intracranial hemorrhage in 4 of 9 pregnancies.
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