Mitral Regurgitation - Valvular Heart Disease Guidelines

Valvular Heart Disease

ACC/AHA Valvular Heart Disease - Mitral Regurgitation GUIDELINES Apps brought to you charge courtesy of Guideline Central and Abbott Vascular.

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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 52

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