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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 01

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Ginecol Obstet Mex 2021; 89 (01)

Anticoagulation in pregnant women with mechanical heart valve: clinical challenge for maternal and fetal balance

Muñoz-Ortiz E, Velásquez-Penagos J, Gándara-Ricardo J, Holguín E, Peláez M, Betancur-Pizarro AM, Velásquez O, Jaramillo CJ

Language: Spanish
References: 13
Page: 43-50
PDF size: 196.86 Kb.


ABSTRACT

Background: Stopping anticoagulation in a pregnant woman with a mechanical valve is not an option. The different anticoagulation schemes offer advantages and disadvantages to the mother and the fetus. Maternal death and thromboembolic phenomena associated with mechanical valve thrombosis are outcomes that can be avoided with appropriate treatment and follow-up.
Objective: To describe the perinatal and cardiovascular outcomes in pregnant women with mechanical heart valves, according to the type of anticoagulant indicated and the recommendations reviewed in the literature.
Methodology: Retrospective study based on the bibliographic search of the MeSH: “anticoagulants”; “heart valve diseases”; “pregnancy”; “mechanical heart valves” and “outcomes” of articles published in PubMed from 2000 to 2020. Articles from scientific societies, systematic reviews and case series comparing different therapeutic schemes were selected.
Resultados: 118 articles were obtained from which 105 were excluded because they were duplicated, prior to the year 2000, they were narrative reviews, case reports and because therapeutic comparisons were not established. 13 met the criteria and motivated the analysis.
Conclusions: With the available evidence it is possible to support decisions in consensus with the patient. Schemes incorporating low-dose warfarin to maintain the appropriate international normalized ratio (INR) are safe for mother and fetus. The indication for low-molecular-weight heparins in the first trimester should always be guided by measuring concentrations of anti-factor Xa; otherwise, the patient should be hospitalized and given an infusion of unfractionated heparin. Care should be offered at institutions with experience in these procedures.


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