Coumarin anticoagulation during pregnancy in patients with mechanical valve prostheses

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Abstract
Between January 1987 and December 1989, 20 female patients with onemechanical valve prosthesis (MVP) for at least 1 year postoperatively werestudied while on coumarin therapy for the full length of pregnancy. In eachcase, caesarean section was scheduled for the 38th week. Patients wereselected according to the following criteria: (1) prothrombin ratiosremaining within the therapeutic range for more than 85% of their totalestimations in the previous 12 months with mean daily doses of warfarinless than 5 mg; (2) stable cardiac status; (3) no previous obstetricdiseases and (4) full acceptance of the risks involved in the protocol. Thepatients were in NYHA functional class I or II. Their ages ranged from 23to 31 years (mean 26 +/- 3). Ten patients had a mitral prosthesis and 10 anaortic prosthesis. Among the 20 mechanical valve prostheses, 10 were Sorin,6 Starr-Edwards, 2 Bjork- Shiley, and 2 Lillehei-Kaster. Eighteen patientswere in sinus rythm, 1 in chronic atrial fibrillation, and 1 had apermanent endocardial pacemaker. Nineteen were delivered by caesareansection: warfarin was withdrawn 48 h before surgery and resumed 24 hthereafter. One patient had premature spontaneous delivery at 36 weeks. Themean prothrombin ratio measured weekly in the 20 patients was 2.06 +/- 0.45INR, using a mean daily warfarin dose of 4.1 mg +/- 1.63. The mean value ofthe prothrombin ratio during caesarean section for the 19 patients was 1.23+/- 0.38 INR. In the 20 live births, the mean birth weight was 2.9 kg +/-0.40.(ABSTRACT TRUNCATED AT 250 WORDS)

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