Treatment of mechanical valve thrombosis during pregnancy

Abstract

SummaryPregnant patients with mechanical valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected, as it is critical for the health of mother and fetus. In this review, we present a pregnant patient with mechanical valve thrombosis (MVT) who underwent thrombolytic therapy, subsequent anticoagulation according to available guidelines, and delivered a healthy baby at full term.

Successful thrombolysis of aortic prosthetic valve thrombosis during first trimester of pregnancy

“…7 For patients with a mechanical prosthetic valve, the incidence of thromboembolism during pregnancy is estimated from 7 to 23% with maximum episodes (50%) in the first trimester, as compared to 14% in the second trimester and 36 % in the third trimester; leading to maternal mortality of 2-15% in different clinical groups. 2,4, 6 The risk is increased due to the hypercoagulable state related to pregnancy, failure to continue Coumadin or due to switch-over to heparin. 1,7 PVT during pregnancy requires immediate therapy such as valve replacement, thrombolysis or surgical thrombectomy.…”

“…The overall mortality rate associated with lytic therapy is 9.9 to 10%, the highest rates are in NYHA class III and IV with 11.9% and 13%, respectively. 1,6,9 Several agents have been administered as fibrinolytic treatment, such as streptokinase, urokinase, tissue plasminogen activator etc. in the second trimester.…”

Intracranial Hemorrhage in Pregnancy

“…We considered reversal of heparin anticoagulation with protamine sulfate; however, we were concerned about the potential risk of rebound hypercoagulability leading to valvular thrombosis, heart failure, thromboembolism, and even maternal mortality 6. The options for management of valve thrombosis include clot lysis with thrombolytic agents or emergency valvular surgery 7. However, in the setting of intracranial hemorrhage, thrombolytic therapy is absolutely contraindicated and the surgical option would have required intravenous UFH infusion during and following surgery that could be fatal in a setting of intracranial bleeding.…”

Warfarin embryopathy: fetal manifestations

“…A significant proportion of these individuals are young women, and prophylactic warfarin therapy is often utilized during pregnancy. In this setting, the risk of valvular thrombosis is balanced against the likelihood of fetal damage in the form of warfarin embryopathy [2].…”