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Case Reports in Cardiology
Volume 2017 (2017), Article ID 3090273, 5 pages
https://doi.org/10.1155/2017/3090273
Case Report

Anticoagulation for the Pregnant Patient with a Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient

1Department of Medicine, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
2Department of Cardiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA

Correspondence should be addressed to Aaron Richardson

Received 26 May 2017; Revised 18 September 2017; Accepted 25 October 2017; Published 22 November 2017

Academic Editor: Magnus Baumhäkel

Copyright © 2017 Aaron Richardson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Heart valve replacement with a mechanical valve requires lifelong anticoagulation. Guidelines currently recommend using a vitamin K antagonist (VKA) such as warfarin. Given the teratogenic effects of VKAs, it is often favorable to switch to heparin-derived therapies in pregnant patients since they do not cross the placenta. However, these therapies are known to be less effective anticoagulants subjecting the pregnant patient to a higher chance of a thrombotic event. Guidelines currently recommend pregnant women requiring more than 5 mg a day of warfarin be switched to alternative therapy during the first trimester. This case report highlights a patient who was switched to alternative therapy during her first pregnancy and suffered a devastating cerebrovascular accident (CVA). Further complicating her situation was during a subsequent pregnancy; this patient continued warfarin use during the first trimester and experienced multiple transient ischemic attacks (TIAs). This case highlights the increased risk of thrombotic events in pregnant patients with mechanical valves. It also highlights the difficulty of providing appropriate anticoagulation for the pregnant patient who has experienced thrombotic events on multiple anticoagulants.