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Anticoagulation for Women with Mechanical Heart Valves during Pregnancy: A Survey

1McGill University, Medicine, Montreal, Canada, 2Queens University, Kingston, Canada, 3St Lawrence College, School of Baccalaureate Nursing, Kingston, Canada, Kingston, Canada, 4Instituto de Salud Pública- Universidad de Buenos Aires, Buenos Aires, Argentina, 5Epidemiología Clínica y Evidencia, Buenos Aires, Argentina, 6University of Toronto, Obstetrics and Gynecology, Toronto, Canada, 7University of Toronto, Medicine, Toronto, Canada, 8University Health Network & Sinai Health System, Division of Cardiology, Toronto, Canada, 9University of Toronto, Toronto, Canada, 10University Health Network & Sinai Health System, Division of Hematology, Toronto, Canada

Abstract Number: PB2517

Meeting: ISTH 2020 Congress

Theme: Women Health » Pregnancy and Pregnancy Complications

Background: The optimal anticoagulation management strategy for pregnant women with mechanical heart valves has not yet been determined. Assessing current anticoagulation practice is a necessary step for planning future prospective studies.

Aims: To determine practice patterns for anticoagulation therapy for pregnant women with mechanical heart valves (MHV).

Methods: We conducted a cross-sectional study using a self-administered online questionnaire. Hematologists, Cardiologists, Obstetric Internists, and Maternal Fetal Medicine specialists were surveyed. Participants included members of professional associations and individuals with pertinent research expertise. The questionnaire consisted of case scenarios and partially closed ended questions. Type and dose of anticoagulant, use of antiplatelet agents, delivery management strategies, and physician demographics were assessed. The project was conducted under the auspice of ISTH’sWomen’s SSC.

Results: 81/117 respondents managed anticoagulation during pregnancy and thus responded to the survey; 62% were Hematologists, 10% Cardiologists, 17% Obstetric Internists, and 4% Maternal Fetal Medicine specialists. Respondents were predominantly from Europe (41%) and North America (37%). In total, 32% of respondents reported using vitamin K antagonists (VKAs) during pregnancy. VKAs with low molecular weight heparin (LMWH) during 6-12 weeks gestation (35%) and therapeutic LMWH antepartum (33%) were the two most common strategies for women with mechanical mitral valves. LMWH was predominantly selected for women with mechanical aortic valves (57%). Location and type of mechanical valve, previous embolic event, and patient preference were among the most common factors guiding decision-making by over 50% of respondents. Low dose Aspirin was considered by 31% of physicians. Delivery was predominantly (55%) selected based on obstetrical indications, and 56% of respondents indicated VKAs are restarted within 72 hours of delivery.

Conclusions: This survey data can be used to inform physician practice and is an initial step for planning research for antepartum anticoagulation in women with mechanical heart valves.

To cite this abstract in AMA style:

Malhame I, Othman M, Casais P, D'Souza R, Wald R, Silversides CK, Sermer M, Shehata N. Anticoagulation for Women with Mechanical Heart Valves during Pregnancy: A Survey [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulation-for-women-with-mechanical-heart-valves-during-pregnancy-a-survey/. Accessed January 26, 2022.

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