Oral anticoagulation throughout pregnancy in patients with mechanical heart valve prosthesis: Safe alternatives

Limited dose warfarin throughout pregnancy in patients with mechanical heart valve prosthesis: a meta-analysis

“…Ten manuscripts fulfilled the selection criteria [1,[7][8][9][10][11][12][13][14][15], to which we have added our prospective data on 55 patients with MVP following LDW throughout pregnancy (unpublished data) [16]. In total, the 11 studies involved 647 patients following different anticoagulation regimens during the course of 853 pregnancies; 574 of which adopted LDW (67.3%).…”

“…As given in Table 1, other anticoagulation regimens included: OA/H in 191 cases (22.4%) [9][10][11][12]15], UDW in 45 cases (5.3%) [7,9,15] and heparin throughout pregnancy in 43 cases (5%) [8,15]. Adjuvant antiplatelet therapy was reported in two studies and included: the use of dypiridamole in patients at high risk of thrombosis (giant left atrium, previous thromboembolic episodes or having a Starr-Edwards cage and ball valve) [1] or a 100 mg aspirin-supplementation to all patients by the second trimester [16]. Three studies were conducted at the same centre and have involved stopping OA just 2 days before a planned Caesarean section, at the end of the 38th week of gestation [1,7,14].…”

“…Three studies were conducted at the same centre and have involved stopping OA just 2 days before a planned Caesarean section, at the end of the 38th week of gestation [1,7,14]. All remaining studies adopted the replacement of OA by subcutaneous [8-11, 13, 15] or continuous intravenous infusion of heparin [12,16] 2-4 weeks before the expected date of delivery, whether per vagina or by Caesarean section, as indicated.…”

“…Fifty patients had double prostheses: mitral and aortic (18%) and only 1 case had both mitral and tricuspid prostheses (0.4%). As reported per patient: 324 out of the 492 patients had a mitral prosthesis (65.8%), 92 had an aortic prosthesis (18.7%) and 76 patients had both mitral and aortic prostheses (15.4%) [1,7,9,10,[12][13][14]16]. Valve types were generally reported per implanted prosthesis, except in three studies where they were reported either per patient [12] or per pregnancy [10,15].…”

“…The remaining ones could not be fully categorized for being described as 'bileaflet valves' [11], 'tilting discs or bileaflet' [10] or just 'mechanical valves' [13], without further manufacturer details. Six studies commented on the presence of AF among patients [1,7,8,13,14,16]. The rate varied from 5% [1] to 47% [16] in the five studies involving mitral (±aortic or tricuspid) valve replacement to complete absence in one study, only including patients with aortic valve replacement [14].…”