Cardiac disease in pregnancy antithrombotic agents

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Special Scenarios: I. Pre-existing Cardiac Disease: Congenital Heart Disease Repaired Congenital Heart Disease Pulmonary Hypertension Rheumatic Heart Disease Connective Tissue Disorders II. Valvular Heart Disease: Mitral Stenosis Mitral Regurgitation Aortic Insufficiency Aortic Stenosis Mechanical Prosthetic Valves Tissue Prosthetic Valves III. Cardiomyopathy: Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Peripartum Cardiomyopathy IV. Cardiac diseases that may develop During Pregnancy: Arrhythmias Acute Myocardial Infarction Hypertension
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Managing Prosthetic Valves During Pregnancy

^[1]

Pregnancy is a thrombogenic milieu
Coumadin use during 1st trimester associated with warfarin embryopathy
Coumadin use in other trimesters postulated to cause CNS abnormalities
Keeping Coumadin dose ≤ 5.0 mg/day appears safe
Recommendations based more on opinion than scientific evidence
SBE Prophylaxis at Delivery

Seventh ACCP Conference Recommendation: Antithrombotic and Thrombolytic Therapy in Pregnancy

In women with prosthetic heart valves, the guideline developers recommend:^[2]

“

Grade 1

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 (Level of Evidence: C), or

2. Aggressive adjusted-dose UFH throughout pregnancy: i.e., administered subcutaneous every 12 hours in doses adjusted to keep the mid-interval aPTT at least twice control or to attain an anti-Xa heparin level of 0.35 to 0.70 U/mL (Level of Evidence: C), or

3. UFH or LMWH until the thirteenth week, change to warfarin until the middle of the third trimester, and then restart UFH or LMWH (Level of Evidence: C)

Remark: Long-term anticoagulants should be resumed postpartum with all regimens

Grade 2

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 (Level of Evidence: C)

”

References

↑ Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M (1999). "Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves". Journal of the American College of Cardiology. 33 (6): 1637–41. PMID 10334435. Retrieved 2012-04-16. Unknown parameter |month= ignored (help)
↑ Bates SM, Greer IA, Hirsh J, Ginsberg JS (2004). "Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl): 627S–644S. doi:10.1378/chest.126.3_suppl.627S. PMID 15383488. Retrieved 2012-04-16. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[pmid10334435-1] Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M (1999). "Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves". Journal of the American College of Cardiology. 33 (6): 1637–41. PMID 10334435. Retrieved 2012-04-16. Unknown parameter |month= ignored (help)

[pmid15383488-2] Bates SM, Greer IA, Hirsh J, Ginsberg JS (2004). "Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl): 627S–644S. doi:10.1378/chest.126.3_suppl.627S. PMID 15383488. Retrieved 2012-04-16. Unknown parameter |month= ignored (help)

[1]

[2]