Cor Vasa 2019, 61(5):534-536 | DOI: 10.1016/j.crvasa.2018.10.002

Pitfalls of anticoagulation therapy in pregnant women with mechanical valve prostheses. The case of two thrombotic events during one pregnancy

Filip Koubek, Jiří Vejvoda, David Alan, Josef Veselka

Department of Cardiology, 2nd Faculty of Medicine and Motol University Hospital, Prague

In anticoagulated patients with mechanical valve prostheses, heparin is still the only possible alternative to warfarin that we choose in some specific situations. One such situation is pregnancy due to the known teratogenic effect of warfarin in a dose-dependent manner. During outpatient treatment with low molecular weight heparin, its efficacy should be monitored regularly and a different target range of the monitored parameter should be kept in mind than with other diagnoses requiring anticoagulation therapy. Despite careful control, there is a considerable risk of treatment failure, particularly due to the unreliable use of the drug in ambulatory conditions and also due to drug level fluctuations at a short elimination half-time. This case report describes the case of a young woman with a mechanical aortic prosthesis who experienced two thrombotic events during one pregnancy. The first episode at the beginning of pregnancy was due to an inappropriate anticoagulation regimen. The second event occurred through adequate treatment with low molecular heparin according to valid recommendations with regular monitoring of efficacy. In both cases, this complication was successfully treated by systemic thrombolysis.

Keywords: Anticoagulation, Pregnancy, Systemic thrombolysis, Valve thrombosis,

Accepted: October 17, 2018; Published: October 20, 2019  Show citation