Management of pregnant women with prosthetic heart valves

Miftahul Afandi, Djoko Soemantri

The choice of anticoagulant agent for pregnant women with mechanical prosthetic heart valves introduces a clinical dilemma for women and the clinicians caring for them. Options include continuing oral anticoagulants (OAC) such as warfarin throughout pregnancy, switching from warfarin to unfractionated heparin or low molecular weight heparin (LMWH) in the first trimester then back to warfarin until close to delivery or taking unfractionated heparin or LMWH throughout pregnancy. The dilemma is that warfarin is the most effective a preventing maternal thromboembolic complications but causes significant fetal morbidity and mortality; unfractionated heparin and in particular LMWH have good fetal outcomes but the risk of thromboembolic complications is high. We reported management anticoagulant for a pregnant woman with mechanical mitral valve prosthetic.

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