Dr Lily Aboud1, Dr Jade Eccles Smith1, Dr Helen Tanner1, Prof William Parsonage2, Dr Karin Lust1, Professor Leonie Callaway1,3
1Department of Obstetric Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 2Department of Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 3Faculty of Medicine, The University of Queensland, Brisbane, Australia
Biography:
Biographies to come
Abstract:
Objective: Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews exist examining perinatal outcomes with bridging anticoagulation.
Design: Retrospective clinical audit, single centre.
Setting: Royal Brisbane and Women’s Hospital, Australia between 1 January 2000, and 1 August, 2022.
Population: All pregnant women with mechanical heart valves (any type) who birthed. METHODS: Review of peripartum and postpartum anticoagulation management.
Main outcome measures: Intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and death.
Results: There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.
Conclusions: Mechanical heart valves requiring bridging anticoagulation are associated with significant maternal morbidity. Most haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data is required to inform evidence-based guidelines for postpartum anticoagulation management.
Funding: Nil funding.
Keywords
mechanical prosthetic heart valves; pregnancy; anticoagulants; pregnancy complications, cardiovascular; haemorrhage; thromboprophylaxis