Women with rheumatic heart disease who have undergone mechanical heart valve replacement face a uniquely high-risk situation during pregnancy. The presence of a mechanical prosthetic valve requires continuous anticoagulation management across all three trimesters.
This protocol addresses pregnant patients with rheumatic heart disease who carry a mechanical heart valve replacement. The combination of pregnancy-related haemodynamic changes and the thrombogenic risk of a mechanical valve demands a carefully structured anticoagulation approach throughout gestation.
Management centres on maintaining anticoagulation throughout the entire pregnancy. The choice of anticoagulant agent — and when to adjust it — depends on individual clinical factors. For some patients, one approach is continued to the end of pregnancy; for others, a more complex algorithm is required.
Full regimen details, sequencing, and decision points available via the protocol below →DOI: 10.1161/CIR.0000000000000921
Women with mechanical valve replacement require anticoagulation throughout the pregnancy, which can include warfarin, unfractionated heparin, or low-molecular-weight heparin.
In women needing warfarin ≤5 mg/d, the medication should be continued until the end of the pregnancy, whereas in others a more complex treatment algorithm needs to be instituted.
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