Why the study?
Pregnant women with mechanical heart valves must alter anticoagulation therapies due to the teratogenic effects of some drugs, requiring reflection on the balance between clinical guidelines and personalized medicine.
Highlights the risk of mechanical valve thrombosis in pregnant women on LMWH and emphasizes the need for dynamic anti-Xa monitoring.
Valve thrombosis on LMWH in pregnancy warrants clinical caution; leaves open optimal regimens for prospective study.
Anticoagulation drugs should be used for patients with mechanical heart valve (MHV) in case of potential risk of thrombosis. Pregnant women with MHV have to change therapies due to teratogenic effect of some anti-coagulation drugs. European Society of Cardiology clinical guidelines for the management of cardiovascular diseases during pregnancy gives specific suggestions for anticoagulation therapy.We have treated 2 patients with mechanical heart valve thrombosis (MVT) during pregnancy: One received low molecular weight heparin (LMWH) throughout the pregnancy and developed MVT at the third trimester of pregnancy; one developed MVT at the first trimester when replacing vitamin K antagonists (VKA) with LMWH. These patients raised secondary reflection on the balance between clinical guideline and personalized medicine. During LMWH therapy, we should dynamically monitor patients' anti-activated factor X (anti-Xa) level to evaluate coagulation function during pregnancy. When a pregnant woman with MHV develops symptoms of acute heart failure, stuck mechanical valve should be paid attention to and surgery should be promptly performed if necessary.
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Huang et al. (2021) studied this question.
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