Anticoagulation for mechanical hear

Anticoagulation for mechanical heart valves should be adjusted, because warfarin must be discontinued during the 1st trimester due to the well-documented risk of embryopathy. Current guidelines support 3 approaches: 1) low-molecular-weight (LMW) heparin administered subcutaneously twice daily throughout pregnancy, 2) unfractionated heparin administered subcutaneously twice daily throughout pregnancy, or 3) unfractionated or LMW heparin administered subcutaneously twice daily until gestational week 13, followed by warfarin from weeks 13 to 35, followed by a return to unfractionated or LMW heparin administered subcutaneously twice daily until delivery.2 Individual management approaches should be discussed jointly by the cardiologist, obstetrician, and patient. Aspirin for bioprosthetic heart valves is safe in pregnancy and need not be adjusted. Antibiotic prophylaxis for delivery (vaginal or caesarean section) is not recommended by the 2008 American Heart Association/American Dental Association guidelines. However, some obstetricians still routinely administer antibiotic agents at the time of rupture of membranes.