Pregnancy outcome in women with mechanical prosthetic heart valvesat their first trimester of pregnancy treated with unfractionated heparin (UFH) or enoxaparin: A randomized clinical trial.

Minoo Movahedi,Mahmood Saeedi,Maryam Motamedi,Parvin Bahrami,Amirreza Sajjadieh,Milad Saeedi

doi:10.34172/jcvtr.2020.35

Abstract

Introduction: Pregnancy increases the risks of thromboembolism for the mother and fetus in patients with mechanical heart valves. The results of some studies have indicated that low molecular weight heparin (LMWH), in comparison with unfractionated heparin (UFH), leads to a lower incidence rate of thrombocytopenia and a decrease in bleeding. Methods: The present randomized clinical trial involved 31 pregnant women with mechanical heart valves at their first trimester (0-14 weeks) of pregnancy. To perform the study, the patients were divided into two groups, i.e. group A (LMWH group-16 patients) and group B (UFH group-15 patients). The birth weight, mode of delivery, and gestational age at birth as well as the maternal and fetal complications were compared between the two groups. Results: The mean age of mothers in the UFH and LMWH groups was 32.67±9.11 and 31.50±5.81years, respectively (P value > 0.05). Although the rate of maternal and fetal complications was higher in the UFH group as compared with the LMWH group, the observed difference was not significant (P value > 0.05). Conclusion: LMWH can be regarded as a safer therapy for both the mother and fetus due to its lower number of refill prescriptions and fewer changes in the blood level.

Highlights

Pregnancy increases the risks of thromboembolism for the mother and fetus in patients with mechanical heart valves
Warfarin has been advocated as a proposed anticoagulant in non-pregnant patients with mechanical heart valves[3]; as it can cross the placenta and impose adverse effects on the fetus by inducing many complications in the fetus, it can even lead to the fetal loss.[4]
The present study evaluated the incidence rate of maternal and fetal complications following the use of low molecular weight heparin (LMWH) in comparison with unfractionated heparin (UFH) in pregnant women with mechanical heart valves

Summary

Introduction

Pregnancy increases the risks of thromboembolism for the mother and fetus in patients with mechanical heart valves. Pregnant women with a mechanical heart valve are a highrisk group, for whom an increased rate of maternal or fetal death during pregnancy has been reported In this regard, some previous studies have reported that only up to 58% of pregnancies were terminated with delivery of live birth.[1] pregnancy increases the thromboembolic disease risks due to inducing hypercoagulable state and the fetal risks.[2]. Warfarin has been advocated as a proposed anticoagulant in non-pregnant patients with mechanical heart valves[3]; as it can cross the placenta and impose adverse effects on the fetus by inducing many complications in the fetus, it can even lead to the fetal loss.[4] there is a risk of bleeding at each stage during the pregnancy. Various regimens have been offered to optimize the use of LMWH in pregnant women with mechanical heart valves.[5]

Methods

Results

Discussion

Conclusion