Key result
Ceasing oral anticoagulants during pregnancy in women with mechanical heart valves led to postnatal valve thrombosis requiring reoperation in 4 of 5 patients.
Why the study?
How do different anticoagulation strategies affect maternal and fetal outcomes in pregnant women with a St. Jude Medical mitral valve prosthesis?
Observational (n=21)
How do different anticoagulation strategies affect maternal and fetal outcomes in pregnant women with a St. Jude Medical mitral valve prosthesis?
Interrupting oral anticoagulation during pregnancy in women with mechanical mitral valves carries an unacceptably high risk of maternal valve thrombosis, highlighting the need for carefully supervised anticoagulation protocols.
Answers are grounded in this paper and cite their sources.
Supports avoiding anticoagulation interruption in pregnancy; hypothesis-generating given small observational cohort.
From 1986 to 1995, 513 young women of childbearing age (11 to 45 years) underwent mitral valve replacement with a bileaflet St. Jude Medical prosthesis. Twenty-one patients became pregnant within 3 years postoperatively. The mean age of these patients at the onset of pregnancy was 27 ± 8 years (range, 16 to 43 years). Follow-up was complete for all pregnant patients. Of 11 who continued to take warfarin during pregnancy, one had a premature delivery, 2 had spontaneous abortions, and 8 had therapeutic abortions. Five patients who ceased oral anticoagulant therapy had normal deliveries but 4 underwent reoperation for valve thrombosis postnatally, with concurrent left hemiplegia in one case. The other 5 patients adhered to an anticoagulation protocol for pregnancy; there were 3 normal deliveries, 1 premature birth, and 1 abortion. There is a high risk of thromboembolism in patients with mechanical heart valves whose anticoagulants are interrupted during pregnancy. We believe that careful supervision can reduce maternal morbidity and mortality.
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Yamak et al. (2000) conducted an observational in Pregnancy with mechanical mitral valve prosthesis (n=21). Interruption of oral anticoagulants vs. Continuation of warfarin or adherence to anticoagulation protocol was evaluated on Maternal and fetal outcomes including valve thrombosis and delivery status. Ceasing oral anticoagulants during pregnancy in women with mechanical heart valves led to postnatal valve thrombosis requiring reoperation in 4 of 5 patients.
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