title: Low-molecular-weight heparin in pregnant women with prosthetic heart valves.
abstract: OBJECTIVE
  Low-molecular-weight heparin (LMWH) is considered a recommended anticoagulation option in pregnant women with prosthetic heart valves. However, few data are available regarding the efficacy and safety of LMWH in this setting.
  
  
  METHODS
  In 1999, the authors' institution developed a standardized anticoagulation protocol for pregnant women with prosthetic heart valves, which included LMWH administered between six and 12 weeks' gestation, and after 36 weeks, with prespecified target levels, and additional low-dose aspirin. Herein is presented the initial experience using this anticoagulation regimen.
  
  
  RESULTS
  Among five women with prosthetic heart valves treated with LMWH during part of their pregnancy, four had uneventful pregnancies while one suffered a coronary artery embolus. A review is provided of the current state of knowledge regarding anticoagulation in pregnancy, with emphasis placed on the importance of strict monitoring of anticoagulation levels.
  
  
  CONCLUSIONS
  Given the drawbacks of other forms of anticoagulation, and within the constraints of available data, LMWH appears--when administered with caution--to be an acceptable alternative in pregnant women with prosthetic heart valves.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Descarries
authors.forename: Line
authors.initials: L
authors.lastname: Leduc
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Lise-Andrée
authors.initials: LA
authors.lastname: Mercier
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000037:antagonists & inhibitors; D001021:Aortic Valve / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000209:etiology; D004359:Drug Therapy, Combination; D004617:Embolism / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D008943:Mitral Valve / Q000601:surgery; D009203:Myocardial Infarction / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology; D011792:Quebec; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D015415:Biomarkers; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D001241:Aspirin