Failure of low molecular-weight heparin in the prevention of prosthetic mitral valve thrombosis during pregnancy: case report and a review of options for anticoagulation.
All mechanical heart valves are thrombogenic and may be associated with thromboembolic complications if anticoagulation is inadequate. This risk is increased in pregnancy due to a hypercoagulable state. The ideal anticoagulation regimen in pregnant patients with prosthetic heart valves is uncertain. Oral dicoumarol anticoagulants, subcutaneous low molecular-weight heparin, subcutaneous high-dose heparin and continuous high-dose intravenous heparin each have their own merits and demerits. A case is presented of a pregnant patient who had prosthetic valve thrombosis while receiving low molecular-weight heparin and who required re-do prosthetic mitral valve replacement. An analysis is also included of the options available for anticoagulating this difficult patient group.
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D003328:Coronary Thrombosis / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000517:prevention & control* / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008943:Mitral Valve / Q000187:drug effects* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications; D012086:Reoperation; D017211:Treatment Failure
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight