Eur J Cardiothorac Surg 2002;22:657
© 2002 Elsevier Science NL
Reply to Vitale et al.
Rainer G. Leyh*,
S. Fischer,
A. Ruhparwar,
A. Haverich
Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Carl Neuberg Strasse 1, 30623 Hannover, Germany
Received 25 June 2002;
accepted 26 June 2002.
* Corresponding author. Tel.: +49-511-532-6581; fax: +49-511-532-5404
e-mail: leyh{at}thg.mh-hannover.de
Key Words: Pregnancy • Anticoagulation • Prosthetic heart valve • Low molecular weight heparin
The study published by Vitale and co-workers [1] regarding dose-dependent fetal complications of warfarin in pregnant women is of great interest for physicians dealing with pregnant women after mechanical heart valve replacement. A significant number of physicians and pregnant women are afraid of the potential fetal complications of warfarin; however, it has to be kept in mind that the mother's health is of utmost importance, since maternal embolic events due to inadequate anticoagulation put both the mother and the fetus at risk. We subsequently described a case of mitral valve thrombosis during pregnancy in a young woman, were warfarin was substituted by low molecular weight heparin [2]. Before pregnancy this patient had a warfarin dose >5 mg; however, her international normalized ratio (INR) varied between 2.0 and 4.2 within the last months before pregnancy. We speculate that sufficient INR management might have the potential to reduce the warfarin dosage in a substantial number of pregnant women, in a way that the warfarin dosage might be reduced to 
5 mg. A perfect anticoagulation management in women with mechanical heart valves during pregnancy is mandatory to reduce maternal and fetal complications. The lack of prospective randomized studies make it difficult to draw definite conclusions about the ideal anticoagulation management in these patients.
References
- Vitale N., De Feo M., De Santo L.S., Pollice A., Tedesco N., Cotrufo M. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol 1999;33:1637-1641.[Abstract/Free Full Text]
- Leyh R.G., Fischer S., Ruhparwar A., Haverich A. Anticoagulation for prosthetic heart valves during pregnancy: is low-molecular-weight heparin an alternative?. Eur J Cardio-thorac Surg 2002;21:577-579.[Abstract/Free Full Text]
