A Case Series of Parturients With Mechanical Mitral Valves

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  Figure 1. Proposed Strategies for Managing Peripartum Anticoagulation All strategies include continuation of daily aspirin 81 mg. Strategy A: For patients without higher than usual risk for MMV thrombosis (defined in Table 2). This applies for IOL as well as scheduled CD. Strategy B: For patients with higher than usual risk for MMV thrombosis (defined in Table 2) undergoing IOL. Of note, UFH is stopped as soon is there is cervical change. For a scheduled CD, UFH would be stopped 4 to 6 hours prior to start of neuraxial anesthesia for the procedure. Strategy C: Strategy used for Patients 2 and 3. UFH was stopped at 5 cm cervical dilation. This was associated with Patient 1’s election for CD due to limited labor analgesic options, Patient 2’s requirement for general anesthesia for emergency CD, and Patient 3’s poor labor analgesia. We recommend reserving this strategy for patients at the highest thrombotic risk. ∗Resume postpartum therapeutic anticoagulation based on patient risk factors for hemorrhage and thrombosis. Obstetric guidelines recommend waiting at least 4 to 6 hours postpartum to start UFH.5 At a minimum, resume UFH ≥1 hour after ELA catheter removal, and ≥4 to 6 hours after…