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Mechanical aortic valve replacement in young women planning on pregnancy: maternal and fetal outcomes under low oral anticoagulation, a pilot observational study on a comprehensive pre-operative counseling protocol.

Abstract

OBJECTIVES
This pilot prospective observational study aimed to evaluate the maternal and fetal outcomes of pregnancies under low-dose oral anticoagulation therapy after aortic mechanical replacement.
BACKGROUND
Need for valve replacement is still an issue for young women with native valve disease who are planning on future pregnancy. Choice of replacement device is a challenging clinical task.
METHODS
A comprehensive pre-operative counseling protocol to guide choice of replacement device was developed. The pre-operative anticoagulation trial to determine the warfarin daily dosage needed to reach target international normalized ratio (INR) represented the main stem of such protocol. Pregnancies on low-dose anticoagulation therapy (target INR: 1.5 to 2.5) were allowed in a highly selected subset of mechanical aortic valve recipients.
RESULTS
Twenty-two patients of 40 originally referred for native valve disease surgery requiring valve replacement, safely underwent the pre-operative anticoagulation challenge. No maternal or fetal complications were detected in 16 pregnancies under low oral anticoagulation. Patterns of warfarin daily dosage and induced INRs were characterized during pregnancy.
CONCLUSIONS
In this small sample observational study, a pre-operative anticoagulation therapy trial helped young women scheduled for valve replacement to acquire complete information as to the choice of prosthetic device. In selected third-generation mechanical aortic prosthesis recipients, low-dose anticoagulation therapy seems safe and feasible for both mother and fetus. Further studies are needed to validate this approach.

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  • Authors

    De Santo LS, Romano G, Della Corte A, D'Oria V, Nappi G, Giordano S, Cotrufo M, De Feo M

    Source

    Journal of the American College of Cardiology 59:12 2012 Mar 20 pg 1110-5

    MeSH

    Administration, Oral
    Adult
    Algorithms
    Anticoagulants
    Aortic Valve
    Bioprosthesis
    Confounding Factors (Epidemiology)
    Counseling
    Drug Administration Schedule
    Female
    Gestational Age
    Heart Valve Diseases
    Heart Valve Prosthesis Implantation
    Heparin, Low-Molecular-Weight
    Humans
    International Normalized Ratio
    Mitral Valve
    Pilot Projects
    Pregnancy
    Pregnancy Complications, Cardiovascular
    Pregnancy Outcome
    Pregnancy Trimesters
    Preoperative Period
    Prospective Studies
    Reoperation
    Thrombosis
    Treatment Outcome
    Warfarin

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22421305