Anticoagulation for prosthetic valve in pregnancy – Cardiology MCQ – Answer

Anticoagulation regimen in pregnancy with prosthetic valve associated with lowest rate of fetal or neonatal loss: Correct answer: d) Low molecular weight heparin

Low molecular weight heparin is associated with lowest rate of fetal or neonatal loss in pregnancy with prosthetic valve, but has a higher risk of valve thrombosis [1]. Though the often followed method is initial use of unfractionated heparin followed by warfarin in second trimester followed by unfractionated heparin in peripartum period, this approach has higher maternal thrombotic and bleeding events. Continuous use of vitamin K antagonists without switch over has better maternal outcomes, but highest fetal losses. Directly acting oral anticoagulants are not recommended for use in those with mechanical prosthetic valves because their use is associated with valve thrombosis.

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Reference

1.  Watkins DA, Beaton AZ, Carapetis JR, Karthikeyan G, Mayosi BM, Wyber R, Yacoub MH, Zühlke LJ. Rheumatic Heart Disease Worldwide: JACC Scientific Expert Panel. J Am Coll Cardiol. 2018 Sep 18;72(12):1397-1416.