The use of low molecular weight heparin during pregnancy in patients with mechanical heart valves carries potential risk for valve thrombosis: a report of three cases.
Pregnancy is associated with an increased risk of valve thrombosis, hemorrhagic complications, and offspring complications in patients with metallic prosthetic heart valve (MHV). Warfarin treatment is the best regimen against thromboembolic complications, but its use in the first trimester can result in embryopathy. Low molecular weight heparin (LMWH) does not cross the placenta and has some potential advantages. However, the pharmacokinetics of LMWHs change during pregnancy, and serial monitoring of anti-Xa levels is strongly recommended. Despite this recommendation, LMWH therapy in a fixed dose is still used in pregnant women with MHV without monitoring anti-Xa activity in clinical practice. We present three cases of MHV thrombosis occurring while on therapy with LMWH during pregnancy. One of these patients showed cerebrovascular event, one presented with pulmonary edema, and one underwent reoperation for MHV thrombosis.
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Utku
U
Senol
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Taner
T
Ulus
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Alparslan
A
Birdane
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Yüksel
Y
Cavuşoğlu
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D013927:Thrombosis / Q000139:chemically induced*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight