Anticoagulation in Pregnant females with mechanical heart valves

Abstract

Objective: To evaluate the complications and outcome of anticoagulation therapy in pregnant females with valvular heart diseases. Design: Descriptive Place and duration of study: The study was conducted at Armed Forces Institute of Cardiology from Jan 2004 to Dec 2004 Patients and methods: All pregnant females with prosthetic heart valves admitted in Armed Forces Institute of Cardiology from Jan 2004 to Dec 2004 were included in this study Basic demographic data including age. duration of pregnancy and complications observed were recorded. Warfarin was replaced with un-fractionated heparin (UFH) in first trimester and after that warfarin was continued with a targeted INR between 2 0-3.0. At 36 weeks warfarin was stopped and UFH was added; however, if patient went into spontaneous labour before this then immediate caesarian section was performed and UFH was restarted 4-6 hours after delivery along with oral warfarin Results: Out of 21 patients, sixteen (76.1%) had mitral valve diseases and five (23.9%) had both mitral and atrial. Majority (42 3%)of patients were in age group 26-30 years Eleven (52.2%) reported in 9th month of gestation Complications observed were hypertension (1), transient ischaemic attacks (1), pulmonary embolism (1), haemoptysis (1) and abortion (1). All patients, except one had successful completion of pregnancy. No case of foetal abnormality was seen In 76% patients, daily dose of warfarin was <5 mg Conclusion: Thrombo-prophylaxis in pregnancy with warfarin and UFH with an INR of 2.0-3.0 is effective in preventing thrombotic complications in females with mechanical valves without resulting in increase haemorrhgic complications.