A B S T R A C T
Objective :To determine maternal (included thromboembolic and haemorrhagic complications) and fetal outcomes (included abortion, stillbirth, baby death and live birth) in women with mechanical heart valves managed with therapeutic dose unfractionated Heparin (UFH) versus enoxaparin during pregnancy.
Methods: this is a prospective comparative, non-randomized study. Pregnant women with mechanical heart valves attending high-risk pregnancy unit high-Benha university hospital, treated with Unfractionated Heparin (UFH) 15,000 U /12 h versus enoxaparin (Clexane) 1mg/kg SC /12h during pregnancy.
Results: 40 pregnant. In 20 pregnancies anticoagulation was with Unfractionated Heparin (UFH) and 20 pregnancies women received enoxaparin. One (3%) thrombotic complications occurred with enoxaparin treatment. Non-compliance or sub-therapeutic levels contributed in this case. Antenatal hemorrage occurred in 4 (10%) and postpartum haemorrhagic complications in 5 (12.5%) pregnancies. Of 32 pregnancies continued after 20 weeks’ gestation, 100% (17/17) of women taking predominantly Unfractionated Heparin (UFH) had a surviving infant compared with 93% (14/15) in women taking primarily enoxaparin (p=0.25). One intrauterine fetal death (IUFD) occurred in enoxaparin group. No significant difference in live birth rate was noticed between the two groups (p=0.31).
Conclusions: Compliance with therapeutic dose Unfractionated Heparin (UFH) during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but meticulous monitoring is essential.