Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

Mustafa Bahloul, Armia Michael, Mansour Y. Kandeel, Ahmed M. Abbas


Background: The current study aims to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA throughout pregnancy.

Methods: An observational was carried out at Assiut Women's Health Hospital, Egypt between February and December 2016. All pregnant women with prosthetic heart valves attending the emergency department during the study period were enrolled in the study. All included patients were classified into two groups; women who receive low molecular weight heparin (LMWH) during the first trimester then shift to warfarin till 36 weeks of gestation then continue on LMWH till delivery (Group I) and those who continue the all period of pregnancy on warfarin (Group II). The primary outcome of the study was the difference in the rate of maternal cardiac complications during labor between both groups.

Results: The study included 72 patients have prosthetic valve replacement and on anticoagulants. Twenty-one were on oral anticoagulant; warfarin (Group II) and 51 pregnant women were on sequential regimen. Both groups were comparable in their basic and clinical data on admission. No difference between both groups in the mode of delivery (p=0.52), postpartum hemorrhage (0.09), sub rectal hematomas (p=0.08), the need for postpartum admission to ICU (p=0.93) and the duration of hospital stay (p=0.47). Additionally, no statistical significant difference between both groups as regard the mean birth weight (p=0.97), Apgar score (p=0.62), fetal sex (p=0.92) and congenital anomalies (p=0.08).

Conclusions: The use of sequential LMWH and oral anticoagulants appears to be a safe option for those women although there is no difference in maternal and fetal outcomes with the use of continuous oral anticoagulants throughout the pregnancy.


Anticoagulants, Heparin, Mitral replacement, Rheumatic heart disease, Warfarin

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