Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

Abstract

In pregnant patients with a prosthetic heart valve (PHV), anticoagulation with warfarin is associated with embryopathy, foetal loss early in pregnancy and maternal bleeding complications in the delivery period. The optimal anticoagulation strategy in the pre-pregnancy period and during pregnancy itself is controversial and a matter of debate. We describe a patient with PHV in the pre-pregnancy period and in a subsequent pregnancy. The optimal anticoagulation treatment strategy in women in their reproductive years with mechanical valve thrombosis is discussed. (Neth Heart J 2007;15: 306-9).

Warfarin embryopathy: fetal manifestations

“…Nevertheless, despite the adverse effects on 30% of fetuses, it has been claimed that the use of warfarin throughout pregnancy offers the greatest protection from thrombosis to the mother with prosthetic heart valves [11,12]. Neither low-molecular weight heparin nor unfractionated heparin crosses the placenta and therefore does not have a teratogenic effect.…”

Pregnancy follow-up in a patient with mechanical valve: possible in sub-Saharan Africa?

“…Two patients who were taking warfarin, subsequently replaced by heparin in the last two weeks of the first trimester had term deliveries. It appears that in almost all cases there were different approaches in the care of pregnant women with prosthetic valve and guidelines for the medical staff were not quite clear [ 9 ]. New information is given in the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease [ 10 ].…”

Prosthetic Valve Thrombosis: About 205 Patients

“…5) Some authors recommend: Thrombolysis in the foreground in the absence of contraindications whatever the degree of obstruction; NYHA; size of the thrombus; reserving surgery in case of contraindication or failure of thrombolysis [6][7][8][9][10]. Others propose it in the event of signs of heart failure or in the absence of a surgical center: lower mortality/surgery [7][8][9][10][11]. 6) Right thrombosis: thrombolysis; Left thrombosis: surgery especially in case of chronic obstruction or left thrombosis [5].…”