Background: Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres. Methods: Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis. Results: Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39–1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by Caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC. Conclusion: Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.

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Keywords anticoagulation, heart valve diseases, High-risk pregnancy, mechanical heart valve, pregnancy complications
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Journal Obstetric Medicine
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Dos Santos, F. (Francois), Baris, L, Varley, A. (Alice), Cornette, J.M.J, Allam, J. (Joanna), Steer, P. (Philip), … Johnson, M.R. (Mark R). (2020). Mechanical heart valves and pregnancy: Issues surrounding anticoagulation. Experience from two obstetric cardiac centres. Obstetric Medicine. doi:10.1177/1753495X20924937