Mechanical Prosthetic Valves and Pregnancy A therapeutic dilemma of anticoagulation
Journal Title: Sultan Qaboos University Medical Journal - Year 2014, Vol 14, Issue 4
Abstract
Choosing the best anticoagulant therapy for a pregnant patient with a mechanical prosthetic valve is controversial and the published international guidelines contain no clear-cut consensus on the best approach. Tis is due to the fact that there is presently no anticoagulant which can reliably decrease thromboembolic events while avoiding damage to the fetus. Current treatments include either continuing oral warfarin or substituting warfarin for subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH) in the frst trimester (6–12 weeks) or at any point throughout the pregnancy. However, LMWH, while widely-prescribed, requires close monitoring of the blood anti-factor Xa levels. Unfortunately, facilities for such monitoring are not universally available, such as within hospitals in developing countries. Tis review evaluates the leading international guidelines concerning anticoagulant therapy in pregnant patients with mechanical prosthetic valves as well as proposing a simplifed guideline which may be more relevant to hospitals in this region.
Authors and Affiliations
Prashanth Panduranga| Departments of Cardiology, Royal Hospital, Muscat, Oman, Mohammed El-Deeb| Departments of Cardiology, Royal Hospital, Muscat, Oman, Chitra Jha| Departments of Obstetrics & Gynaecology, Royal Hospital, Muscat, Oman
Keywords
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