Anticoagulation in pregnant women with prosthetic heart valves.
BACKGROUND
Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. Effective anticoagulation is therefore critical in such patients but remains problematic, since oral anticoagulation and both unfractionated and low-molecular-weight heparin may be associated with important fetal and maternal side effects.


OBJECTIVE
To review information related to the use of anticoagulation with both warfarin and heparin and reassess the safety and efficacy of these therapies in pregnant women with mechanical prosthetic heart valves.


METHODS
A MEDLINE search from 1966 to October 2003 for English and non-English language articles that reported the use of anticoagulation in pregnancy was conducted. Articles were included if they reported use of anticoagulation in pregnancy with emphasis on those that included women with mechanical prosthetic heart valves.


CONCLUSIONS
Anticoagulation prophylaxis with both warfarin and heparin (unfractionated heparin and low-molecular-weight heparin) may be associated with important fetal and maternal side effects. Optional regimens for the treatment of low-risk and high-risk patients are proposed to minimize potential complications.
Division of Cardiovascular Medicine, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA. elkayam@usc.edu
Uri
U
Elkayam
Harpreet
H
Singh
Adil
A
Irani
Mohammed W
MW
Akhter
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D013923:Thromboembolism / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin