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| {{Cardiac disease in pregnancy}}
| | #REDIRECT [[Cardiac disease in pregnancy and valvular heart disease]] |
| {{CMG}}; {{AOEIC}} {{CZ}}
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| ==Managing Prosthetic Valves During Pregnancy==
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| <ref name="pmid10334435">{{cite journal |author=Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M |title=Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves |journal=[[Journal of the American College of Cardiology]] |volume=33 |issue=6 |pages=1637–41 |year=1999 |month=May |pmid=10334435 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00044-3 |accessdate=2012-04-16}}</ref>
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| * [[Pregnancy]] is a thrombogenic milieu
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| * [[Coumadin]] use during 1st trimester associated with warfarin embryopathy
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| * [[Coumadin]] use in other trimesters postulated to cause CNS abnormalities
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| * Keeping [[Coumadin]] dose ≤ 5.0 mg/day appears safe
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| * Recommendations based more on opinion than scientific evidence
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| * SBE Prophylaxis at Delivery
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| ==Seventh ACCP Conference Recommendation: Antithrombotic and Thrombolytic Therapy in Pregnancy==
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| *In women with [[prosthetic heart valves]], the guideline developers recommend:<ref name="pmid15383488">{{cite journal |author=Bates SM, Greer IA, Hirsh J, Ginsberg JS |title=Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy |journal=[[Chest]] |volume=126 |issue=3 Suppl |pages=627S–644S |year=2004 |month=September |pmid=15383488 |doi=10.1378/chest.126.3_suppl.627S |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=15383488 |accessdate=2012-04-16}}</ref>
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| {{cquote|
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| ====[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 1]]====
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| '''1.''' Adjusted-dose, twice-daily [[LMWH]] throughout pregnancy in doses adjusted either to keep a 4-hour postinjection anti-Xa heparin level at approximately 1.0 to 1.2 U/mL (preferable) or according to weight ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'', or
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| '''2.''' Aggressive adjusted-dose [[UFH]] throughout pregnancy: i.e., administered subcutaneous every 12 hours in doses adjusted to keep the mid-interval a[[PTT]] at least twice control or to attain an anti-Xa heparin level of 0.35 to 0.70 U/mL ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'', or
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| '''3.''' [[UFH]] or [[LMWH]] until the thirteenth week, change to [[warfarin]] until the middle of the third trimester, and then restart [[UFH]] or [[LMWH]] ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
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| ::''Remark:'' Long-term anticoagulants should be resumed postpartum with all regimens
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| ====[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 2]]====
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| '''1.''' In women with prosthetic heart valves at high risk, the guideline developers suggest the addition of low-dose [[aspirin]], 75 to 162 mg/day ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Cardiology]]
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| [[Category:Electrophysiology]]
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| [[Category:Emergency medicine]]
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