Tuesday, 29. of July 2014
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Pregnancy under anticoagulation therapy – a high risk?

The next speaker, Heinrich Koertke, MD, Bad Oeynhausen (Germany), focused on the topic of pregnant women with mechanical heart valves and lifelong anticoagulation. “Is there a contra-indication for pregancy in women with mechanical heart valves? If there is the wish to have a baby, this complex question should be openly discussed between the gynecologist and the cardiologist. Patient INR self-management is a crucial part in these discussions,” said Koertke.

Based on the findings from international studies, which partly differ from international guidelines, Koertke suggests the following procedure in the case of pregnancy: After the exclusion of warfarin resistance, an INR value within the range of 1.2 to 2.1 (target: 2.0) in aortic valve replacement and 2.0 to 2.5 (target: 2.3) in the case of a mitral or double valve replacement should be achieved using low-dose warfarin therapy. These INR target ranges were found in the ESCAT III study, where the Institute for Applied Telemedicine (IFAT) in Bad Oeynhausen introduced a telemedical approach for INR patient management using CoaguChek® XS point-of-care systems, mobile transmitters and electronic patient records.

“Vitale et al were able to prove that 33 pregnancies under continuous warfarin treatment below 5 mg resulted in the birth of 33 healthy children, without complications for the mothers and the children”, stated Koertke. “We have managed several patients who received this kind of care: We only stopped the warfarin therapy and offered heparin 14 days prior to childbirth. We should bear in mind that the administration of heparins, conventional as well as unfractionated, also needs tight control during pregnancy.”

Report by Thomas Klein, MD, MSc (Nov. 2009)