Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience

Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):320-3. doi: 10.1016/j.ejogrb.2011.09.011. Epub 2011 Oct 1.

Abstract

Objective: This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens.

Study design: A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome.

Results: The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage.

Conclusion: No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.

Publication types

  • Comparative Study

MeSH terms

  • Abortion, Spontaneous / etiology
  • Academic Medical Centers
  • Acenocoumarol / adverse effects
  • Acenocoumarol / therapeutic use
  • Adult
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Female
  • Heart Valve Diseases / surgery
  • Heart Valve Prosthesis / adverse effects*
  • Heparin / adverse effects
  • Heparin / therapeutic use
  • Humans
  • Incidence
  • India / epidemiology
  • Medical Records
  • Mitral Valve / surgery
  • Postpartum Hemorrhage / etiology
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Pregnancy Complications / prevention & control
  • Pregnancy Complications, Cardiovascular / surgery
  • Pregnancy Complications, Hematologic / etiology
  • Pregnancy Complications, Hematologic / prevention & control*
  • Pregnancy Outcome
  • Retrospective Studies
  • Thrombosis / etiology
  • Thrombosis / prevention & control
  • Warfarin / adverse effects
  • Warfarin / therapeutic use
  • Young Adult

Substances

  • Anticoagulants
  • Warfarin
  • Heparin
  • Acenocoumarol