56
Table 37. Pregnancy and VHD (cont'd)
Recommendations
COR LOE
Medical erapy
erapeutic anticoagulation with frequent monitoring is
recommended for all pregnant patients with a mechanical
prosthesis.
I B
Warfarin is recommended in pregnant patients with a
mechanical prosthesis to achieve a therapeutic INR in the
second and third trimesters.
I B
Discontinuation of warfarin with initiation of IV
unfractionated heparin (UFH) (with an activated partial
thromboplastin time [aPTT] >2 times control) is
recommended before planned vaginal delivery in pregnant
patients with a mechanical prosthesis.
I C
Low-dose ASA (75–100 mg ) once per day is recommended
for pregnant patients in the second and third trimesters with
either a mechanical prosthesis or bioprosthesis.
I C
Continuation of warfarin during the first trimester is
reasonable for pregnant patients with a mechanical prosthesis
if the dose of warfarin to achieve a therapeutic INR is ≤5 mg
daily aer full discussion with the patient about risks and
benefits.
IIa B
Dose-adjusted low-molecular-weight heparin (LMWH) at least
2 times per day (with a target anti-Xa level of 0.8–1.2 U/mL,
4–6 hours postdose) during the first trimester is reasonable for
pregnant patients with a mechanical prosthesis if the dose of
warfarin is >5 mg daily to achieve a therapeutic INR.
IIa B
Dose-adjusted continuous IV UFH (with aPTT ≥2 times
control) during the first trimester is reasonable for pregnant
patients with a mechanical prosthesis if the dose of warfarin is
>5 mg daily to achieve a therapeutic INR.
IIa B
Dose-adjusted LMWH ≥2 times per day (with a target anti-
Xa level of 0.8–1.2 U/mL, 4–6 hours postdose) during the
first trimester may be reasonable for pregnant patients with a
mechanical prosthesis if the dose of warfarin is ≤5 mg daily to
achieve a therapeutic INR.
IIb B
Dose-adjusted continuous infusion of UFH (with aPTT ≥2
times control) during the first trimester may be reasonable for
pregnant patients with a mechanical prosthesis if the dose of
warfarin is ≤5 mg daily to achieve a therapeutic INR.
IIb B
LMWH should NOT be administered to pregnant patients
with mechanical prostheses unless anti-Xa levels are
monitored 4–6 hours aer administration.
III:Harm B
Pregnancy and VHD
