Pregnancy with a prosthetic heart valve, thrombosis, and bleeding: the ESC EORP Registry of Pregnancy and Cardiac disease III
European Heart Journal
Abstract
Pregnancy in women with a prosthetic heart valve is considered high risk, primarily due to the need for effective anticoagulation. However, data on the relationship between anticoagulation practices and pregnancy outcomes are very limited.
The Registry of Pregnancy and Cardiac disease is a global registry that prospectively enrolled pregnancies in women with a prosthetic heart valve between January 2018 and April 2023. Detailed data on anticoagulation, including dosage and monitoring, and cardiovascular, pregnancy, and perinatal outcomes were collected.
In total, 613 pregnancies were included of which 411 pregnancies were in women with a mechanical valve and 202 were in women with a biological valve. The chance of an uncomplicated pregnancy with a live birth in women with a mechanical valve was 54%, compared with 79% in women with a biological valve (
More favourable outcomes were found in women with a biological valve compared with a mechanical valve. In women with a mechanical valve, the use of LMWH was associated with an increased risk of thromboembolic complications. A mitral prosthetic valve was identified as a predictor for valve thrombosis. The benefit could not be confirmed nor refuted, in terms of reduced thromboembolic events, from using anti-Xa level monitoring in women on LMWH.
Contributors
J Grewal
Author
M Janzen
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P A Román Rubio
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R Vasallo Peraza
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G Vázquez Hernández
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J E Pérez Torga
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Y Gil Jiménez
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M Meluzá Martín
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R Almaleh
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G Youssef
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K Sorour
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S Abebe
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D Mekonnen
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Justin P Gnanaraj
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Hasan Al Farhan
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Isabelle Malhamé
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C Fekadu
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D Yadeta
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Catherine M Otto
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S Dupuis-Girod
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Roman Vasallo Peraza
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L Delagrange
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M Richardson
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Ariane Marelli
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L Ghesquiere
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O Domanski
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Aldo P Maggioni
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Jerome M J Cornette
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M Gonzalez Estevez
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Mark R Johnson
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Y Ould Hamoud
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S Gautier
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L Marsili
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L Bal-Theoleyre
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S Palazzolo
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Roger Hall
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M Ladouceur
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G Jondeau
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Jolien Roos-Hesselink
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A Bourgeois Moine
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Roger Hall
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William Parsonage
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Werner Budts
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Julie de Backer
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Jasmin Grewal
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L Eliaou
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Ariane Marelli
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O Milleron
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M Tchitchinadze
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Guillaume Jondeau
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Mark Johnson
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Y Dulac
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C Karsenty
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Catherine Otto
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Karen Sliwa
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N Souletie
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F Bajanca
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Aldo P Maggioni
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C Rickers
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K Vardanyan
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A Melkonyan
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S Blankenberg
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H Lachikyan
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C Sinning
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K Hakobyan
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C Magnussen
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E Zengin
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M Mazmanian
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G Mueller
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H Hayrapetyan
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R Schnabel
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A Tavaracyan
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Y Von Kodolitsch
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R Kozlik-Feldmann
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H Baumgartner
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A Hellige
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A Rietkötter
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