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Updated: Oct 24, 2025

In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac
Francois Dos Santos1, Lucia Baris2, Alice Varley1
1Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Background:
Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres.
Methods:
Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis.
Results:
Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39-1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC.
Conclusion:
Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.
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