Table 34. 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 UFH (with
an 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 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
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