Document Detail


Use of low molecular weight heparin in pregnant women with mechanical heart valves.
MedLine Citation:
PMID:  19840573     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There are a number of different anticoagulation options for pregnant women with mechanical heart valves. The purpose of this study was to examine maternal thromboembolic complications in women with mechanical valves treated with low-molecular weight heparin (LMWH) throughout pregnancy. This was a substudy of a larger prospective cohort study of pregnant women with heart disease followed from 1998 to 2008. All pregnant women with mechanical left-sided valves who were treated with LMWH throughout pregnancy were included. Maternal thromboembolic events were defined as valve thrombosis, need for valve replacement, or stroke during pregnancy or postpartum (up to 6 months). Twenty-three pregnancies (17 women) occurred in women treated with LMWH and low-dose aspirin: 15 in women with mechanical mitral valves, 9 in women with mechanical aortic valves, and 1 in a woman with both. There was 1 maternal thromboembolic event (4%), which resulted in maternal and fetal death. Five women (22%) developed other adverse cardiac events during pregnancy. Nine pregnancies (43%) had fetal or neonatal adverse events, 5 of which had favorable outcomes. Three pregnancies were complicated by postpartum hemorrhage. In conclusion, carefully monitored LMWH may be a suitable anticoagulation strategy in pregnant women with mechanical heart valves who are unwilling to use warfarin. However, this group of women remains at risk for maternal cardiac and fetal complications. The occurrence of valve thrombosis resulting in maternal death despite therapeutic anti-Xa levels highlights current limitations with anticoagulation in this population.
Authors:
Yoav Yinon; Samuel C Siu; Chelsie Warshafsky; Cynthia Maxwell; Anne McLeod; Jack M Colman; Mathew Sermer; Candice K Silversides
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-09-16
Journal Detail:
Title:  The American journal of cardiology     Volume:  104     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-20     Completed Date:  2009-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1259-63     Citation Subset:  AIM; IM    
Affiliation:
Mount Sinai Hospital, University of Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / therapeutic use*
Aortic Valve / surgery
Arrhythmias, Cardiac / epidemiology
Female
Fetal Death / epidemiology
Heart Valve Prosthesis / adverse effects*
Heparin, Low-Molecular-Weight / therapeutic use*
Humans
Mitral Valve / surgery
Postpartum Hemorrhage / chemically induced,  epidemiology
Pregnancy
Pregnancy Complications, Cardiovascular / epidemiology,  prevention & control*
Prospective Studies
Stroke / epidemiology,  prevention & control
Thromboembolism / epidemiology,  prevention & control*
Grant Support
ID/Acronym/Agency:
53130//Canadian Institutes of Health Research; 93722//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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