VPB0514 - LMWH safety and efficacy in pregnancy with rheumatic heart disease patients with heart valves replacement

Background: The risk of thromboembolic complications is higher in pregnancy than at other times especially in Rheumatic heart disease patients who underwent heart valve replacement. Thus, maintenance of therapeutic anticoagulation during pregnancy is needed to diminish the chance of thromboembolic complications.

Aims: Investigated the efficacy and safety of LMWH in the management of RHD-related valvular disease management in pregnant women.

Methods: A retrospective study was conducted at King Saud Medical City between January 2011- February 2020. All pregnant women with rheumatic heart disease and who had heart valve replacements were reviewed in this study. The reviewed patients were on one of the following regimens: LMWH, LMWH plus warfarin, or Unfarctinated heparin plus warfarin. Primary endpoints were thromboembolism, hemorrhagic complications, and fetal outcomes.

Results: A total of 744 pregnancies in 149 women were identified. The mean age ± SD of the women was 43.8 ± 12 years. Eighty-six women (58%) were on LMWH regimen, thirty-five women (23%) were on LMWH and warfarin regimen, and twenty-eight women (19%) were Unfarctinated heparin and warfarin regimen. Overall, thromboembolic compilations developed in five (0.7 %) pregnancies of these, two were in the LMWH group, two were in the LMWH and warfarin group, and one in the heparin and warfarin group. In addition, significant hemorrhage occurred in five pregnancies. Of these, two occurred in the LMWH group, two in the LMWH and warfarin group, and one in the heparin and warfarin group.

Conclusion(s): This study presents the largest retrospective study of LMWH use in pregnant women with RHD and had a valve replacement. This study has assured that LMWH is safe and effective in preventing thrombosis in pregnancy. Further studies including randomized controlled trials investigating the use of LMWH for these indications are encouraged.