Therapy With Coumarin During Pregnancy in Patients With Heart Valve Prostheses [15R

Abstract

INTRODUCTION: Anticoagulation during pregnancy is complicated because of potential risks for mother and fetus. The use of coumarin in pregnant women with prosthetic heart valves is questioned for the teratogenic effects. The objective of this study is determine fetal outcomes in women with mechanical heart valves managed with coumarin during pregnancy. METHODS: Women with mechanical heart valves treated with coumarin at any stage during pregnancy at Instituto Nacional de Perinatología (2009–2014) was identified and a retrospective database was done. RESULTS: Seventeen women was included in this study. 58.8% (10/17) had a history of rheumatic fever, 76.5% (13/17) with mechanical heart valve prostheses and 23.5% (4/17) biological. The average age of the placement mechanical heart valves was 15 years (range 3–22 years) and the average age during pregnancy was 25 years (range 19–33 years). All patients received anticoagulation during pregnancy (acenocumarine, warfarin, unfractionated heparin and low molecular weight heparin). 47% (8/17) of patients receiving coumarin during the first trimester. 15 healthy newborns (88%) were obtained without structural malformations and 2 miscarriage during the first trimester in patients treated with low molecular weight heparin. CONCLUSION: The anticoagulant therapy in patients with mechanical heart valves during pregnancy prevents thromboembolic complications and is associated with maternal and fetal satisfactory results. The presence of fetal malformations were not identified in this case series. The use of coumarin is contraindicated during the first 12 weeks of pregnancy, after these weeks and postpartum studies indicate that it is harmless.