Is Oral Anticoagulant with High dose in Pregnant Women with Prosthetic Mechanical Valve Effective and Safe?

Document Type : Original Article

Authors

1 Cardiology Department, Faculty of Medicine, Zagazig University

2 Department of Cardiothoracic surgery, Faculty of Medicine, Zagazig University

3 Cardiothoracic Surgery, Faculty of Medicine, Zagazig University

4 Department of Anatomy & Emberyology, Faculty of Medicine, Zagazig University

Abstract

Background: The management of women with prothetic valves in pregnancy remains challenging. Anticoagulation in these subgroups has many controversies.
Aim: We aim to evaluate the safety dose of oral anticoagulant in pregnant women with mechanical valve prosthesis in first trimester.
Patients &Methods: Pregnant ladies with well functioning prothetic valves were enrolled. Patients were divided into 3 groups: Group A took oral anticoagulant < 5 mg warfarin with therapeutic INR. Group B took low molecular weight heparin (LMWH) twice daily and monitoring is done every week by antifactorXa 4-6 hours post-injection to keep about 1 IU/ml. Group C took oral anticoagulant in dose > 5 mg warfarin to reach therapeutic INR.
Results: There was significant difference between groups in vaginal bleeding and abortion, with more bleeding and abortion in group Busing LMWH. There was a high rate of malfunction valve about 19.9% in group B, but no reportedcases of malfunction valve in the other both groups using warfarin.
Conclusion: Warfarin with dose > 5 mg in pregnant women with mechanical prosthetic valve is as safe for mother and baby as warfarin with dose < 5 mg. Both regimens are safer than LMWH.

Keywords

Zagazig University Medical Journal
Volume 26, Issue 3
Pediatrics,Cardiology,Internal Medicine,Community Medicine,Chest,Rheumatology,Dermatology&Psychiatry
May 2020
Pages 450-454

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