Evaluation OF Last Guidelines And Studies about The Best Treatment With Anticoagulant During Pregnancy in Woman with Mechanical Heart Valves

Document Type : Review Article

Authors

1 Assistant professor, Department of Cardiovascular Surgery, Imam Reza (AS) Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Intern, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate professor, Department of Obstetrics and Gynecology, Women's Health Research center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Associate professor, Department of Cardiovascular Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: All women with prosthetic heart valve should undergo long-term treatment with anticoagulants drugs. Anticoagulants suitable for use in the treatment of pregnant women with prosthetic heart valves has met with controversy. Due to limited information on the strategies used in the treatment of pregnant women with prosthetic heart valve, this study was performed with aim to evaluate the advantages and disadvantages of the use of anticoagulants in pregnant women with prosthetic valve to achieve key points for medical use.
Methods: To access the performed studies about anticoagulant therapy in pregnant women with prosthetic valve, databases of PUBMED، MEDLINE، SCOPUS و EMBASE و DARE and also, related keywords were used. Last guidelines related to the coagulant therapy after surgery of prosthetic heart valve were studied.
Conclusion: best coagulation regimen in pregnant women with mechanical valve is using warfarin with dose <5 mg.   

Keywords

References

  1. Nishimura RA, Warnes CA. Anticoagulation during pregnancy in women with prosthetic valves: evidence, guidelines and unanswered questions. Heart (British Cardiac Society) 2015; 101(6):430-5.
  2. Castellano JM, Narayan RL, Vaishnava P, Fuster V. Anticoagulation during pregnancy in patients with a prosthetic heart valve. Nature reviews Cardiology 2012; 9(7):415-24.
  3. Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol 2005; 46(3):403-10.
  4. Elkayam U, Goland S. The search for a safe and effective anticoagulation regimen in pregnant women with mechanical prosthetic heart valves. J Am Coll Cardiol 2012; 59(12):1116-8.
  5. Danik S, Fuster V. Anticoagulation in pregnant women with prosthetic heart valves. Mt Sinai J Med 2004;71(5):322-9.
  6. Elkayam U, Singh H, Irani A, Akhter MW. Anticoagulation in pregnant women with prosthetic heart valves. J Cardiovas Pharmacol Ther 2004 ;9(2):107-15.
  7. McLintock C. Thromboembolism in pregnancy: challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves. Best Pract Res Clin Obstet Gynaecol 2014; 28(4):519-36.          
  8. McLintock C, McCowan LM, North RA. Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparin. BJOG 2009;116(12):1585-92.
  9. Nassar AH, Hobeika EM, Abd Essamad HM, Taher A, Khalil AM, Usta IM. Pregnancy outcome in women with prosthetic heart valves. Am J Obstet Gynecol 2004; 191(3):1009-13.
  10. Pieper PG, Balci A, Van Dijk AP. Pregnancy in women with prosthetic heart valves. Netherlands Heart Journal 2008; 16(12):406-11.
  11. McLintock C. Anticoagulant choices in pregnant women with mechanical heart valves: balancing maternal and fetal risks--the difference the dose makes. Thromb Res 2013; 131 (Suppl 1):S8-10.
  12. Suri V, Keepanasseril A, Aggarwal N, Chopra S, Bagga R, Sikka P, et al. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol 2011;159(2):320-3.
  13. Basude S, Hein C, Curtis S, Clark A, Trinder J. Low‐molecular‐weight heparin or warfarin for anticoagulation in pregnant women with mechanical heart valves: what are the risks? A retrospective observational study. BJOG 2012; 119(8):1008-13.
  14. Regitz-Zagrosek V, Lundqvist CB, Borghi C, Cifkova R, Ferreira R, Foidart J-M, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011;32(24):3147-97.
  15. Castellano JM, Narayan RL, Vaishnava P, Fuster V. Anticoagulation during pregnancy in patients with a prosthetic heart valve. Nat Rev Cardiol 2012;9(7):415-24.
  16. Torella M, Torella D, Nappi G, Chiodini P, Torella M. Oral Anticoagulation after Mechanical Heart Valve Replacement: Low Intensity Regimen can Make the Difference. J Clin Exp Cardiolog 2014;5(319):2.
  17. Oran B, Lee-Parritz A, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb haemost 2004; 92(4):747-51.
  18. Abildgaard U, Sandset PM, Hammerstrom J, Gjestvang FT, Tveit A. Management of pregnant women with mechanical heart valve prosthesis: thromboprophylaxis with low molecular weight heparin. Thrombos Res 2009; 124(3):262-7.
  19. Turpie AG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Eng J  Med 1993; 329(8):524-9.

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