Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres.
High-risk pregnancy
anticoagulation
heart valve diseases
mechanical heart valve
pregnancy complications
Journal
Obstetric medicine
ISSN: 1753-495X
Titre abrégé: Obstet Med
Pays: England
ID NLM: 101464191
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
05
12
2019
accepted:
05
04
2020
entrez:
16
8
2021
pubmed:
17
8
2021
medline:
17
8
2021
Statut:
ppublish
Résumé
Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres. Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis. Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39-1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC. Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
Sections du résumé
BACKGROUND
BACKGROUND
Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres.
METHODS
METHODS
Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis.
RESULTS
RESULTS
Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39-1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC.
CONCLUSION
CONCLUSIONS
Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
Identifiants
pubmed: 34394718
doi: 10.1177/1753495X20924937
pii: 10.1177_1753495X20924937
pmc: PMC8358247
doi:
Types de publication
Journal Article
Langues
eng
Pagination
95-101Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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