title: Home heparin therapy used in a pregnant patient with a mechanical heart valve prosthesis.
abstract: The optimal anticoagulation therapy for pregnant patients with a mechanical valve prosthesis is uncertain, but teratogenic effects and the high incidence of fetal loss associated with dicumarol derivatives limit the use of these agents as anticoagulants in this setting. A patient with a mechanical valve prosthesis, in the first trimester of pregnancy, stopped taking her warfarin because of personal fears about teratogenicity. Prosthetic valve thrombosis developed, and she required redo mitral valve replacement. Another mechanical prosthesis was inserted without maternal or fetal injury. The patient was maintained on continuous home, intravenous, high-dose heparin therapy for the remainder of her pregnancy. This therapy resulted in a successful pregnancy and delivery without valve thrombosis, hemorrhagic events, or maternal or fetal compromise.
authors.affiliation: Division of Cardiothoracic Surgery, Albany Medical College, New York 12208.
authors.forename: V A
authors.initials: VA
authors.lastname: Ferraris
authors.forename: R R
authors.initials: RR
authors.lastname: Klingman
authors.forename: L
authors.initials: L
authors.lastname: Dunn
authors.forename: S
authors.initials: S
authors.lastname: Fein
authors.forename: M
authors.initials: M
authors.lastname: Eglowstein
authors.forename: R
authors.initials: R
authors.lastname: Samelson
mesh_terms: D000328:Adult; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000601:surgery; D006333:Heart Failure / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008943:Mitral Valve; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery
chemical_list: D006493:Heparin