Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres
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Accepted version
Author(s)
Type
Journal Article
Abstract
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
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
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
Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
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
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
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
Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
Date Issued
2020-06-02
Date Acceptance
2020-04-05
Citation
Obstetric Medicine, 2020, 14 (2), pp.95-101
ISSN
1753-495X
Publisher
SAGE Publications
Start Page
95
End Page
101
Journal / Book Title
Obstetric Medicine
Volume
14
Issue
2
Copyright Statement
© The Author(s) 2020. The final, definitive version of this paper has been published in Dos Santos, F., Baris, L., Varley, A., Cornette, J., Allam, J., Steer, P., … Johnson, M. R. (2020). Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres. Obstetric Medicine by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/1753495X20924937
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000537488500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
High-risk pregnancy
pregnancy complications
heart valve diseases
mechanical heart valve
anticoagulation
EUROPEAN-SOCIETY
ANTI-XA
WOMEN
THERAPY
DISEASE
Publication Status
Published
Article Number
UNSP 1753495X20924937
Date Publish Online
2020-06-02