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Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation
Adil A M Al-Lawati1, M Venkitraman, Taha Al-Delaime
1Cardiothoracic Surgery Unit, Royal Hospital Muscat, Sultanate of Oman, PO Box 225, Code 115, Muscat, Oman. adilawati@yahoo.com
Objectives:
To establish a uniform anticoagulation regimen for pregnant patients with mechanical heart valves taking into account the socio-economic background and to evaluate the incidence of anticoagulant related complications.
Methods:
A retrospective study on 63 pregnancies in 21 women with mechanical heart valves was evaluated. These pregnancies were divided into two groups: Group I (n=42) received oral anticoagulants throughout pregnancy and Group II (n=21) received subcutaneous heparin in the 1st trimester and oral anticoagulants for the rest of pregnancy period. Both groups received heparin at time of delivery.
Results:
There was no case of coumarin embryopathy seen and there was no maternal death. Life threatening valve thrombosis occurred in two patients who were both from Group II and needed emergency re-replacement. Group I had a higher incidence of spontaneous abortion than Group II although this was not statistically significant.
Conclusions:
The role of coumarin embryopathy has been overstated. We recommend the use of oral anticoagulants throughout pregnancy especially in countries with similar socio-economic background.