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.

Links

Publisher Full Text

Authors

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

Institution

Department of Cardiovascular Surgery and Transplant, V Monaldi Hospital, Naples, Italy. luca.desanto@ospedalemonaldi.it

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