Anti-Coagulation During Pregnancy in Women with Mechanical Heart Valves: A Prospective Study

International Journal of Fertility and Sterility

Saeid Hosseini¹  Mehdi Haddadzadeh²  Ali Reza Alizadeh Ghavidel²  Fahimeh Kashfi²  Amir Jamshid Khamoushi² 

[1] Epidemiology and Reproductive Health Department, Royan Institute for R;Heart Valve Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center,Tehran University of Medical Science, Tehran, Iran;

关键词: mechanical heart valve;    anticoagulant;    heparin;    warfarin;    pregnancy;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background Pregnancy is associated with a hypercoagulable state, therefore the optimalanticoagulants for potential use in pregnant women with prosthetic heart valves are controversial.The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and theirpotential risks in pregnant women with mechanical heart valves.Materials and Methods In this prospective cohort study, we followed 44 women with 49pregnancies who had mechanical heart valves from September 2002 to September 2007. A totalof 38 patients took warfarin throughout their pregnancies (group A). In 11 patients, warfarin waschanged to heparin during the first trimester and then again to warfarin during 12thto 36thweeksof gestational age (group B). All women took warfarin from 36thweeks of gestational age untildelivery.Results In group A, there were 22 live births (57.9%), 15 abortions (39.5%) and 1 maternal death(2.6%). In group B, there were seven live births (63.6%), three spontaneous abortions (27.3%) andone intra-uterine fetal death (9.1%). There was no significant difference in live birth rate betweenthe two groups (p=0.24). Thirty-three pregnancies (86.8%) in group A and five pregnancies (45.4%)in group B had no maternal complications (p=0.004). The difference in pregnancy complicationsbetween both groups was significant (p < 0.001)Conclusion The present study shows that low dose warfarin (5 mg/day or less) may be safeduring the first trimester of pregnancy. Maternal adverse events are low when pregnant womenwith mechanical heart valves remain on a warfarin regimen. The risk of embryopathy does notnecessarily increase.

【 授权许可】

Unknown