AHA GUIDELINES Bundle (free trial)

2017 Update Incorporated - Valvular Heart Disease

AHA GUIDELINES Apps brought to you courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/362033

Contents of this Issue

Navigation

Page 55 of 63

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

Articles in this issue

Archives of this issue

view archives of AHA GUIDELINES Bundle (free trial) - 2017 Update Incorporated - Valvular Heart Disease