TY - JOUR
T1 - Mechanical heart valves and pregnancy
T2 - Issues surrounding anticoagulation. Experience from two obstetric cardiac centres
AU - Dos Santos, Francois
AU - Baris, Lucia
AU - Varley, Alice
AU - Cornette, Jerome
AU - Allam, Joanna
AU - Steer, Philip
AU - Swan, Lorna
AU - Gatzoulis, Michael
AU - Roos-Hesselink, Jolien
AU - Johnson, Mark R.
N1 - Funding Information:
None. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Publisher Copyright:
© The Author(s) 2020.
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85085877178&partnerID=8YFLogxK
U2 - 10.1177/1753495X20924937
DO - 10.1177/1753495X20924937
M3 - Article
C2 - 34394718
AN - SCOPUS:85085877178
SN - 1753-495X
VL - 14
SP - 95
EP - 101
JO - Obstetric Medicine
JF - Obstetric Medicine
IS - 2
ER -