Efficacy of low‐dose, subcutaneously administered heparin in treatment of pregnant women with artificial heart valves

Wang, Rebecca Y. C.; Lee, Pui Kee; Chow, Joseph S. F.; Chen, Walter W. C.

doi:10.5694/j.1326-5377.1983.tb122360.x

Cited by 34 publications

(9 citation statements)

References 4 publications

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“…However, several case series have shown that heparin is associated with an unacceptable risk of thromboembolism. [17][18][19] Thus, subcutaneous heparin should be considered only for low-risk patients, that is, those with no history of thromboembolism and with newer models of prosthetic valves.…”

Section: Adjust the Inr According To Valve Type And Locationmentioning

confidence: 99%

Caring for patients with prosthetic heart valves.

Bettadapur¹,

Griffin²,

Asher³

2002

Cleveland Clinic Journal of Medicine

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Patients with prosthetic heart valves require regular examinations and echocardiograms, antithrombotic therapy, and appropriate antibiotic prophylaxis against endocarditis. Physicians must also be on the alert for several uncommon but potentially devastating complications: valve structural failure, thrombosis, embolism, endocarditis, paravalvular leak, and hemolytic anemia. s KEY POINTS Doppler echocardiography should be performed regularly to monitor left ventricular function and valve structure and to screen for stenosis or regurgitation. Auscultation can identify many valvular problems. Antithrombotic therapy is begun shortly after implantation. Goals are different for different valve types. Patients with prosthetic valves require antibiotic prophylaxis against endocarditis before dental treatment and other procedures. If thrombosis is detected, the first goal is to optimize the anticoagulation therapy. Surgery or thrombolysis may be required for larger thromboses.

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Section: Adjust the Inr According To Valve Type And Locationmentioning

confidence: 99%

Caring for patients with prosthetic heart valves.

Bettadapur¹,

Griffin²,

Asher³

2002

Cleveland Clinic Journal of Medicine

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“…123,124.128,129.132.136,140,141 Other studies have also shown similar complications with intravenous heparin anticoagu-lant therapy during pregnancy. 122,128,140,141 In these studies, the achieved level of anticoagulation was not adequately monitored, and a high proportion of first-generation valves were used, which have a pronounced thromboembolic potential. Investigators'v':" have suggested that higher doses of heparin (for example, 35,000 to 40,000 U per 24 hours) to increase the APTT to at least 2,0 times the control value, especially in the setting of newer generation valves, would be more effective, but this strategy has not been tested.…”

Section: Pregnancy and Anticoagulationmentioning

confidence: 99%

Modern Management of Prosthetic Valve Anticoagulation

Tiede

Nishimura

Gastineau

et al. 1998

Mayo Clinic Proceedings

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Prosthetic heart valves have been effectively used for many years. Nonetheless, they are associated with risks of thrombosis and thromboembolic events, as well as anticoagulation-induced bleeding. Substantial changes in anticoagulation measurement and dosing have occurred during the past several years. In this review, the rationale for anticoagulation in patients with prosthetic heart valves, the changes in monitoring and dosing, and the comparison of relevant anticoagulation trials are discussed. On the basis of the existing data, new recommendations regarding lower anticoagulation levels are offered, utilizing a single value goal rather than the traditional therapeutic range. Perioperative management of anticoagulation is discussed in light of the available literature, and major drug interactions are reviewed.

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“…A dose of 5000 U of heparin every 12 hours is insufficient for the prevention of thromboem bolism. 46,48 Administration of subcutaneous heparin should be continued until 1 week before delivery when the patient should be hospitalized and switched to a heparin infusion, which is continued until the induc tion of labor. At that time, the patient is switched to low-dose, subcutaneous heparin, 5000 U every 8 hours.…”

Section: Antithrombotic Therapy During Pregnancymentioning

confidence: 99%

“…49,50 To be certain that there is not an unusual situation, the PT of the infant should be checked on one occasion after the nursing mother is back on warfarin therapy and has been nursing the infant regularly. Since the beneficial use of subcutane ous heparin with mechanical prosthetic valves during pregnancy is not fully proven, [46][47][48] a bioprosthetic heart valve is preferred for women of childbearing age who wish to bear children because many do not require long-term anticoagulant therapy. However, the risk of bioprosthetic calcification and need for reoperation in very young women has to be kept in mind.…”

Section: Antithrombotic Therapy During Pregnancymentioning

confidence: 99%