Routine prophylaxis management of specific cardiac events
such as rheumatic fever and infective endocarditis was performed
according to conventional strategies.4, 5
The routine strategy adopted against thromboembolic episodes
was as follows: (1) In patients with mechanical prostheses,
coumadin was stopped and heparin was used instead in
two periods: during the first trimester of gestation and from
Week 34 of gestation until 2 days after delivery; in the remaining
period coumadin was maintained. Daily doses of subcutaneous
unfractioned heparin was used: either 30,000 U to
achieve 11⁄2 to 2 times of activated partial thromboplastin time
(APTT), or low-molecular weight heparin doses at 1 mg/kg
t.i.d. (2) In atrial fibrillation, pulmonary hypertension or cyanotic
heart disease, subcutaneous unfractioned heparin or lowmolecular
weight heparin was employed from Week 24 of
gestation until 2 days after delivery, at daily doses of 20,000 U
or 40 mg, respectively. In both situations, coumadin was introduced
2 days after delivery, adjusted to a target International
Normalized Ratio (INR) of 2.0 to 3.5.