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Recommendations for the anticoagulation of pregnant patients with mechanical heart valves

Elise Schapkaitz, Barry Frank Jacobson, Pravin Manga, Rufaro Saeed Chitsike, Estee Benade, Sylvia Haas, Harry R Buller

Abstract


Background. The management of pregnant patients with mechanical heart valves remains challenging because there are no large randomised studies to provide guidelines for effective anticoagulant therapy. Both vitamin K antagonists and heparins may be associated with maternal and foetal adverse events.

Method. The Southern African Society of Thrombosis and Haemostasis reviewed available literature and comprehensive evidence-based guidelines for the anticoagulation of pregnant patients with mechanical heart valves. A draft document was produced and revised by consensus agreement. The guidelines were adjudicated by independent international experts to avoid local bias.

Results and conclusion. We present concise, practical guidelines for the clinical management of pregnant patients with mechanical heart valves. Recommendations reflect current best practice which will hopefully lead to improved anticoagulation practice in this select group of high risk patients.


Authors' affiliations

Elise Schapkaitz, Charlotte Maxeke Johannesburg Academic Hospital, South Africa; Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

Barry Frank Jacobson, Division of Clinical Haematology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Pravin Manga, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Rufaro Saeed Chitsike, Medicine Memorial University of Newfoundland Health Sciences Center, Newfoundland, Canada

Estee Benade, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Sylvia Haas, Technical University of Munich, Germany

Harry R Buller, Academic Medical Centre, University of Amsterdam, Netherlands

Full Text

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Keywords

mechanical prosthetic heart valves, pregnancy, anticoagulation

Cite this article

South African Medical Journal 2015;105(9):733-738. DOI:10.7196/SAMJnew.7928

Article History

Date submitted: 2015-01-23
Date published: 2015-09-14

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