52
Figure 8. Anticoagulation of Pregnant Patients With
Mechanical Valves
Pregnant Patient With
Mechanical Valve
Continue warfarin
with close INR
monitoring
(IIa)
Baseline warfarin
dose >5 mg daily
Pregnancy and VHD
OR
Dose-adjusted
LMWH ≥2x daily
(target anti-Xa level
0.8–1.2 U/mL
4–6 h postdose)
(IIb)
OR
Dose-adjusted
continuous infusion
of UFH (with aPTT
≥2x control)
(IIb)
First
trimester
OR
Dose-adjusted
continuous infusion
of UFH (with aPTT
≥2x control)
(IIa)
Second and third
trimesters
Before planned
vaginal delivery
Discontinue warfarin and dose-
adjusted continuous infusion of UFH
(with aPTT ≥2x control)
(I)
Baseline warfarin
dose ≤5 mg daily
Therapeutic anticoagulation
with frequent monitoring
(I)
Warfarin to goal INR plus
ASA 75–100 mg QD
(I)
First
trimester
Dose-adjusted
LMWH ≥2x daily
(target anti-Xa level
0.8–1.2 U/mL
4–6 h postdose)
(IIa)
