Use of Antithrombotic Agents During Pregnancy: Conclusion
Prophylaxis in Patients With Mechanical Heart Valves
The management of pregnant patients with mechanical heart valves is problematic because the efficacy of heparin is not established. Nevertheless, it is likely that full doses of heparin are effective in preventing systemic embolism. Two approaches have been recommended (both are grade C2): the first is to use heparin therapy throughout pregnancy administered ql2h by subcutaneous injection in doses adjusted to keep the midinterval APTT in the therapeutic range (at least twice control) or an anti-Xa heparin level of 0.35 to 0.70 U/mL; the second approach is to use heparin until the 13th week, to change to warfarin until the middle of the third trimester, and then to restart heparin therapy until delivery. Although the latter approach might avoid warfarin embryopathy, other fetopathic effects (eg, CNS abnormalities) are still possible. Allergy medications Reading here Therefore, before this approach is recommended, the potential risks should be explained to the patients. A further potential problem with the use of oral anticoagulants during pregnancy arises from the clear statement in the manufacturer’s package insert that coumarin is contraindicated during pregnancy. This statement carries with it medicolegal implications that would also have to be discussed with the patient if a choice is made to use oral anticoagulants during pregnancy. Pregnancy and APLA.
Pregnant patients with APLA and a history of multiple pregnancy losses should be treated with aspirin plus heparin (grade A1 recommendation). Patients with APLA and a history of venous thrombosis should be treated with long-term anticoagulant therapy. During pregnancy, we use adjusted-dose subcutaneous heparin (grade C2 recommendation). In the absence of previous venous thrombosis and pregnancy loss, pregnant patients with APLA should be considered to be at risk for the development of venous thrombosis and either followed with clinical surveillance or treated with low-dose subcutaneous heparin or LMWH (grade C2 recommendation).