J Korean Med Sci.  2007 Apr;22(2):258-261. 10.3346/jkms.2007.22.2.258.

Low Molecular Weight Heparin Treatment in Pregnant Women with a Mechanical Heart Valve Prosthesis

• Lee JH
• Park NH
• Keum DY
• Choi SY
• Kwon KY
• Cho CH

• KMID: 1713183
• DOI: http://doi.org/10.3346/jkms.2007.22.2.258

Abstract

No definitive recommendation is available concerning optimal antithrombotic therapy in pregnant women with a mechanical heart valve. The purpose of the current study was to evaluate the clinical results of nadroparin treatment with respect to pregnancy outcome and maternal complications. From 1997 to 2005, 31 pregnancies were reviewed in 25 women. Nadroparin (7,500 U, twice daily) was used in 23 pregnancies between 6 and 12 weeks of gestation and close-to-term only, and coumarin derivatives were used with aspirin at other times. Eight pregnant women treated with coumarin derivatives throughout pregnancy were compared to evaluate the safety and efficacy of nadroparin. No maternal death or bleeding complication occurred in either of the two groups, and frequencies of maternal thromboembolism including valve thrombosis (8.7% vs. 12.5%, p>0.05) were similar. However, the frequencies of live born (91.3% vs. 50%, p=0.01) and healthy babies (90.4% vs. 25%, p<0.01) were significantly higher, and the fetal loss rate was significantly lower (8.7% vs. 50%, p=0.01) in the nadroparin-treated group. Regarding the efficacy and safety of antithrombotic treatment in pregnant women with prosthetic heart valves, nadroparin treatment during the first trimester is an acceptable regimen and produces better results than coumarin derivatives.

Keyword

Low Molecular Weight Heparin; Heart Valve Prosthesis; Pregnant Women

MeSH Terms

Treatment Outcome
Thrombosis/etiology/*prevention & control
Pregnancy Outcome
Pregnancy Complications, Cardiovascular/*etiology/*prevention & control
Pregnancy
Nadroparin/*administration & dosage/*adverse effects
Hydrocephalus/chemically induced
Humans
Heart Valve Prosthesis/*adverse effects
Heart Valve Diseases/etiology/*prevention & control
Female
Coumarins/administration & dosage
Adult

Reference

1. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med. 2000. 160:191–196.

2. Cotrufo M, De Feo M, De Santo LS, Romano GP, Corte AD, Renzulli A, Gallo C. Risk of warfarin during pregnancy with mechanical valve prostheses. Obstet Gynecol. 2002. 99:35–40.

3. Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol. 1999. 33:1637–1641.

4. Meschengieser SS, Fondevila CG, Santarelli MT, Lazzari MA. Anticoagulation in pregnant women with mechanical heart valve prostheses. Heart. 1999. 82:23–26.

5. Nassar AH, Hobeika EM, Abd Essamad HM, Taher A, Khalil AM, Usta IM. Pregnancy outcome in women with prosthetic heart valves. Am J Obstet Gynecol. 2004. 191:1009–1013.

6. Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolisom in pregnancy: a systemic review of safety and efficacy. Blood. 2005. 106:401–407.

7. Montalescot G, Polle V, Collet JP, Leprince P, Bellanger A, Gandjbakhch I, Thomas D. Low molecular weight heparin after mechanical heart valve replacement. Circulation. 2000. 101:1083–1086.

8. Shapira Y, Sagie A, Battler A. Low-molecular-weight heparin for the treatment of patients with mechanical heart valves. Clin Cardiol. 2002. 25:323–327.

9. McColl , Greer IA. Low-molecular-weight heparin for the prevention and treatment of venous thromboembolism in pregnancy. Curr Opin Pulm Med. 2004. 10:371–375.

10. Rowan JA, McCowan LME, Raudkivi PJ, North RA. Enoxaparin treatment in women with mechanical heart valves during pregnancy. Am J Obstet Gynecol. 2001. 185:633–637.

11. Leyh RG, Fischer S, Ruhparwar A, Haverich A. Anticoagulation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternatives? Eur J Cardiothorac Surg. 2002. 21:577–579.

12. Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy: the seventth ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004. 126:627S–644S.

13. Ginsberg JS, Chan WS, Bates SM, Kaatz S. Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med. 2003. 163:694–698.

14. Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation. 2003. 107:1240–1246.

15. Mclintock C, North RA, White HD. Prosthetic heart valves and pregnancy. Circulation. 2003. 108:e159–e160.

16. Lovenox Injection [package insert]. 2002. Bridgewater, NJ: Aventis Pharmaceuticals Inc.

17. Oran B, Lee-Parritz A, Ansell J. Low molecular weight heparin for the prophylaxis of thromboembolism in women with prosthetic mechanical heart valves during pregnancy. Thromb Haemost. 2004. 92:747–751.

18. Barbour LA, Oja JL, Schultz LK. A prospective trial that demonstrates that dalteparin requirements increase in pregnancy to maintain therapeutic levels of anticoagulation. Am J Obstet Gynecol. 2004. 191:1024–1029.