Anticoagulation in a pregnant patient with mechanical heart valves: Case reports and literature review

Patients with prosthetic mechanical heart valves require a life-long anticoagulation. This is more so during pregnancy which increases the risk of thrombosis. We present two pregnant patients with prosthetic mechanical valves managed up to delivery. All the patients were on warfarin before conception which was changed to unfractionated heparin after confirmation of pregnancy. At 14 weeks gestation, they were changed back to warfarin until 36 weeks gestation. Unfractionated heparin was reintroduced until delivery. All the patients had minimal postpartum hemorrhage. Mrs. XX, one of them, had four successful deliveries since the placement of mechanical valve. Pregnancy for a woman mechanical valve poses a greater risk to both the mother and the fetus. This group of women should have preconception care in a specialized program.