Anticoagulation in pregnant women with mechanical heart valves: A case series from a single centre in South India over two decades

Abstract

Context: Women with mechanical valve replacement (MVR) are on anticoagulants (AC), and this poses a big challenge in management during pregnancy. Adequate anticoagulation and the risk of haemorrhage/bleeding is as to be balanced to avoid adverse events.

Aims: The objectives of this study are to identify the AC regimes used in these pregnancies, the tests used for monitoring these regimes, the perinatal outcomes of the pregnancy, and the complications in the mother.

Setting and design: This retrospective study was done in a large tertiary centre. Information from computerized databases and case notes, from the years 2004 to 2024, identified 127 pregnancies in 83 women with MVR. In this setting, oral Vitamin-K Antagonists (VKA) were usually continued in the first trimester. In the peripartum period, a switch to parenteral heparin was done. Details of all pregnancies were captured, and descriptive statistics were done.

Results: In the first trimester, 111 pregnancies received VKA, 14 received unfractionated heparin (UFH), and 2 received LMWH. In the 3^rd trimester, they were given UFH 40/88 (45.5%) of the time, LMWH 27/88 (30.6%), and 21/88 (23.8%) went into labour while on VKA. There were 3 deaths due to cardiac failure with a maternal mortality rate of 3/83 (3.6%). There were 6/83 (7.2%) cases of Thromboembolic complications (TEC) and 12/127 (9.7%) cases of postpartum haemorrhage. There were 35/127 (28%) abortions. Stillbirths: 7%. 52% delivered by caesarean section and 48% delivered vaginally.

Conclusion: The oral inexpensive AC regime that addresses patient compliance and safety has results comparable to other parenteral regimes.

Keywords: Heparin analogue; maternal death; metallic valve replacement; obstetric complication; thromboembolic complication; vitamin-K antagonists.