PMID- 18980086
OWN - NLM
STAT- MEDLINE
DCOM- 20090123
LR  - 20161124
IS  - 0966-8519 (Print)
IS  - 0966-8519 (Linking)
VI  - 17
IP  - 5
DP  - 2008 Sep
TI  - Anticoagulant management of pregnancy following heart valve replacement in the 
      United Kingdom, 1986-2002.
PG  - 526-32
AB  - BACKGROUND AND AIM OF THE STUDY: Patients with mechanical heart valves require 
      anticoagulation which is associated with significant maternal mortality (1-4%) 
      and fetal complications (31%) in pregnancy. The study aim was to identify 
      anticoagulant protocols and outcomes for pregnant women undergoing heart valve 
      replacement (HVR) in the United Kingdom. METHODS: Women aged between 18 and 45 
      years and registered with the United Kingdom Heart Valve Registry (UKHVR) each 
      completed a questionnaire, and their obstetric notes were reviewed. The data 
      analyzed included valve type (mechanical, bioprosthetic, homograft), valve site 
      (mitral, aortic, tricuspid, pulmonary), anticoagulation at confirmation of 
      pregnancy, between 6-12 weeks and from 12 weeks to term, delivery, maternal and 
      fetal outcomes, and cause of death. The summary statistics and a descriptive 
      review of the findings are reported. RESULTS: Of 2,532 women eligible for the 
      study, 922 responded. Among these women, 72 became pregnant, with 60 pregnancies 
      in the mechanical valve (MV) group and 45 in the tissue valve (TV) group. Three 
      anticoagulation regimes were used during early pregnancy: unfractionated heparin 
      (UFH), low-molecular-weight heparin (LMWH) or warfarin. All women received 
      warfarin in the second trimester and heparin for delivery. Live births were 
      recorded in 30% of MV pregnancies and in 60% of TV pregnancies. Miscarriage rates 
      differed markedly (37% MV versus 2% TV). Fetal outcome was poorest in the 
      warfarin-only group, with embryopathy occurring at a dose level of 6 mg. The 
      maternal outcomes did not differ significantly among groups. High-dose heparin 
      during the first trimester and for delivery was effective for the majority of 
      mechanical valves. CONCLUSION: The study results illustrate the diverse and 
      uncertain manner in which UKHVR patients are managed during pregnancy. A national 
      notification system would record much-needed prospective information on 
      anticoagulation and pregnancy outcomes, thus aiding evidence-based management.
FAU - Shannon, Muriel S
AU  - Shannon MS
AD  - Department of Haematology, St. George's Hospital, London. mshannon@sgul.ac.uk
FAU - Edwards, Maria-Benedicta
AU  - Edwards MB
FAU - Long, Fiona
AU  - Long F
FAU - Taylor, Kenneth M
AU  - Taylor KM
FAU - Bagger, Jans Peder
AU  - Bagger JP
FAU - De Swiet, Michael
AU  - De Swiet M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Heart Valve Dis
JT  - The Journal of heart valve disease
JID - 9312096
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Abortion, Spontaneous/mortality
MH  - Adolescent
MH  - Adult
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - *Bioprosthesis
MH  - Cause of Death
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Fetal Diseases/chemically induced/mortality
MH  - Heart Failure/mortality
MH  - *Heart Valve Prosthesis Implantation
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Middle Aged
MH  - Postoperative Complications/*drug therapy/mortality
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/*drug therapy/mortality
MH  - Pregnancy Outcome
MH  - Risk Factors
MH  - United Kingdom
MH  - Warfarin/adverse effects/therapeutic use
EDAT- 2008/11/05 09:00
MHDA- 2009/01/24 09:00
CRDT- 2008/11/05 09:00
PHST- 2008/11/05 09:00 [pubmed]
PHST- 2009/01/24 09:00 [medline]
PHST- 2008/11/05 09:00 [entrez]
PST - ppublish
SO  - J Heart Valve Dis. 2008 Sep;17(5):526-32.