Uri Elkayam1, Harpreet Singh, Adil Irani, Mohammed W Akhter. 1. Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA. elkayam@usc.edu
Abstract
BACKGROUND: Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. Effective anticoagulation is therefore critical in such patients but remains problematic, since oral anticoagulation and both unfractionated and low-molecular-weight heparin may be associated with important fetal and maternal side effects. PURPOSE: To review information related to the use of anticoagulation with both warfarin and heparin and reassess the safety and efficacy of these therapies in pregnant women with mechanical prosthetic heart valves. DATA SOURCE AND SELECTION: A MEDLINE search from 1966 to October 2003 for English and non-English language articles that reported the use of anticoagulation in pregnancy was conducted. Articles were included if they reported use of anticoagulation in pregnancy with emphasis on those that included women with mechanical prosthetic heart valves. CONCLUSIONS: Anticoagulation prophylaxis with both warfarin and heparin (unfractionated heparin and low-molecular-weight heparin) may be associated with important fetal and maternal side effects. Optional regimens for the treatment of low-risk and high-risk patients are proposed to minimize potential complications.
BACKGROUND: Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. Effective anticoagulation is therefore critical in such patients but remains problematic, since oral anticoagulation and both unfractionated and low-molecular-weight heparin may be associated with important fetal and maternal side effects. PURPOSE: To review information related to the use of anticoagulation with both warfarin and heparin and reassess the safety and efficacy of these therapies in pregnant women with mechanical prosthetic heart valves. DATA SOURCE AND SELECTION: A MEDLINE search from 1966 to October 2003 for English and non-English language articles that reported the use of anticoagulation in pregnancy was conducted. Articles were included if they reported use of anticoagulation in pregnancy with emphasis on those that included women with mechanical prosthetic heart valves. CONCLUSIONS: Anticoagulation prophylaxis with both warfarin and heparin (unfractionated heparin and low-molecular-weight heparin) may be associated with important fetal and maternal side effects. Optional regimens for the treatment of low-risk and high-risk patients are proposed to minimize potential complications.
Authors: Vera Regitz-Zagrosek; Christa Gohlke-Bärwolf; Annette Geibel-Zehender; Markus Haass; Harald Kaemmerer; Irmtraut Kruck; Christoph Nienaber Journal: Clin Res Cardiol Date: 2008-09 Impact factor: 5.460
Authors: Anselm Uebing; Michael A Gatzoulis; Constantin von Kaisenberg; Hans-Heiner Kramer; Alexander Strauss Journal: Dtsch Arztebl Int Date: 2008-05-09 Impact factor: 5.594