Cardiology MCQ – Anticoagulation in pregnancy – Answer

Cardiology MCQ – Anticoagulation in pregnancy – Answer

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Best maternal outcomes in mechanical prosthetic valves with pregnancy is obtained with:

Correct answer: 3. Warfarin

Best maternal outcome in pregnancy with mechanical prosthetic valves is obtained with warfarin [1]. But it is a known teratogen and is associated with lowest number of live births. Low molecular weight heparin probably gives the best fetal outcome, though the maternal risk of thromboembolism is higher. Dabigatran is not recommended for mechanical prosthetic valves even without pregnancy.

Generally warfarin is avoided in first trimester and near term and heparin or low molecular weight heparin used instead. Some studies have shown that warfarin doses less than 5 mg have less fetal toxicity. Best fetal outcome may be with low molecular weight heparin used throughout pregnancy. But there is a higher risk of maternal thromboembolic events compared to warfarin.

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Reference

  1. D’Souza R, Ostro J, Shah PS, Silversides CK, Malinowski A, Murphy KE, Sermer M, Shehata N. Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis. Eur Heart J. 2017; 38:1509–1516.