Cemal Levent BİRİNCİOĞLU, Muhammet Onur HANEDAN, Anıl ÖZEN, Veysel BAŞAR, Ertekin Utku ÜNAL, Hakkı Zafer İŞCAN, Adem DİKEN

Mekanik kalp kapağı olan gebe kadınlarda antikoagülasyon tedavisi

Amaç: Bu çalışmada, farklı antikolagülan rejimlerinin protez kapak ile ilişkili komplikasyonlar ve feto-maternal mortalite ve morbidite üzerindeki etkileri araştırıldı ve en ideal antikolagülan tedavi rejimi belirlendi. Çalışma planı: Ocak 1990 - Aralık 2015 tarihleri arasında mekanik kalp kapak replasmanı yapılan gebe kadınlarda antikoagülan tedavi rejimleri, retrospektif olarak incelendi. Mekanik kalp kapak replasmanı sonrası 57 hastada 72 gebelik gözden geçirildi ve dört farklı rejim belirlendi ve gebeliğin farklı trimesterlerinde değerlendirildi. Bulgular: Yetmiş iki gebeliğin, 40'ı sağlıklı yeni doğanla, 35’i (%48.6) sağlıklı yenidoğan, dördü (%5.6) prematüre doğum ve biri (%1.4) düşük doğum ağırlığı ile sonuçlandı. On sekiz (%25) terapötik ve 12 (%16.7) spontan düşüğün yanı sıra, iki (%2.8) ölü doğum izlendi. Gebelik süresince veya post-partum dönemde, yedi gebede kapak trombozu gelişti. Altı hastada (%10.5) kanama ve yine altı (%10.5) hastada periferik emboli meydana geldi. Maternal mortalite görülmedi. Sonuç: Gebelik sırasında en ideal antikoagülasyon rejimine ilişkin tam bir fikir birliği olmamasına rağmen, birinci trimesterde varfarinin teratojenisite ve artmış düşük riskini önlemek için doz ayarlamalı fraksiyone olmayan heparin veya düşük molekül ağırlıklı heparin ile değiştirilmesi uygundur. Düşük molekül ağırlıklı heparinin uygulaması kolaydır ve güvenilir bir şekilde izlenebilir ve başarılı gebelik sonuçlarına da vesile olabilir. Ancak, gebeliğin tüm trimesterleri süresince, günde ≤5 mg varfarini geçmemek kaydıyla kullanılacak varfarin, embriyopati riskinin gebe tarafından kabul edildiği durumlarda, alternatif bir seçenek olabilir.

Anticoagulation therapy in pregnant women with mechanical heart valve

Background: This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen.Methods: Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. Results: Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded.Conclusion: Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecular-weight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ≤5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman.

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