{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:46:38Z","timestamp":1787071598339,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Women with mechanical valve replacement (MVR) are on anticoagulants (AC), and this poses a big challenge in management during pregnancy. Adequate anticoagulation and the risk of haemorrhage\/bleeding is as to be balanced to avoid adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>The objectives of this study are to identify the AC regimes used in these pregnancies, the tests used for monitoring these regimes, the perinatal outcomes of the pregnancy, and the complications in the mother.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Design:<\/jats:title>\n                    <jats:p>This retrospective study was done in a large tertiary centre. Information from computerized databases and case notes, from the years 2004 to 2024, identified 127 pregnancies in 83 women with MVR. In this setting, oral Vitamin-K Antagonists (VKA) were usually continued in the first trimester. In the peripartum period, a switch to parenteral heparin was done. Details of all pregnancies were captured, and descriptive statistics were done.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In the first trimester, 111 pregnancies received VKA, 14 received unfractionated heparin (UFH), and 2 received LMWH. In the 3\n                      <jats:sup>rd<\/jats:sup>\n                      trimester, they were given UFH 40\/88 (45.5%) of the time, LMWH 27\/88 (30.6%), and 21\/88 (23.8%) went into labour while on VKA. There were 3 deaths due to cardiac failure with a maternal mortality rate of 3\/83 (3.6%). There were 6\/83 (7.2%) cases of Thromboembolic complications (TEC) and 12\/127 (9.7%) cases of postpartum haemorrhage. There were 35\/127 (28%) abortions. Stillbirths: 7%. 52% delivered by caesarean section and 48% delivered vaginally.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The oral inexpensive AC regime that addresses patient compliance and safety has results comparable to other parenteral regimes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_313_25","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T15:01:29Z","timestamp":1758639689000},"page":"3434-3437","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulation in pregnant women with mechanical heart valves: A case series from a single centre in South India over two decades"],"prefix":"10.4103","volume":"14","author":[{"given":"Arpudh Michael","family":"Anandaraj","sequence":"first","affiliation":[{"name":"Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily D.","family":"Ebenezer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie P.","family":"Vijjeswarapu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiny E.","family":"Nirupama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Cardio Thoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukesh C.","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmya","family":"Sathyendra","sequence":"additional","affiliation":[{"name":"Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudha","family":"Jasmine","sequence":"additional","affiliation":[{"name":"Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhosh J.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Rathore","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowri","family":"Mahasampath","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiji Elizabeth","family":"Mathews","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"R1-20250924","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1001\/archinte.160.2.191","article-title":"Anticoagulation of pregnant women with mechanical heart valves:A systematic review of the literature","volume":"160","author":"Chan","year":"2000","journal-title":"Arch Intern Med"},{"key":"R2-20250924","first-page":"1","article-title":"Anticoagulation of pregnant women with mechanical heart valve prosthesis:A systematic review of the literature (2000\u20132009)","volume":"2","author":"Hassouna","year":"2010","journal-title":"J Coagul Disord"},{"key":"R3-20250924","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/1471-0528.14478","article-title":"Pregnancy outcomes in women with mechanical prosthetic heart valves:A prospective descriptive population based study using the United Kingdom Obstetric Surveillance System (UKOSS) data collection system","volume":"124","author":"Vause","year":"2017","journal-title":"BJOG"},{"key":"R4-20250924","first-page":"448","article-title":"Pregnancy with prosthetic heart valves-30 years'nationwide experience in Denmark","volume":"40","author":"Sillesen","year":"2011","journal-title":"Eur J Cardiothorac Surg"},{"key":"R5-20250924","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/CIRCULATIONAHA.115.015242","article-title":"ROPAC Investigators and the EUR Observational Research Programme (EORP) Team. Pregnancy in women with a mechanical heart valve:Data of the European society of cardiology registry of pregnancy and cardiac disease (ROPAC)","volume":"132","author":"van","year":"2015","journal-title":"Circulation"},{"key":"R6-20250924","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1111\/1471-0528.13491","article-title":"Prosthetic heart valves in pregnancy, outcomes for women and their babies:A systematic review and meta-analysis","volume":"122","author":"Lawley","year":"2015","journal-title":"BJOG"},{"key":"R7-20250924","doi-asserted-by":"crossref","first-page":"2681","DOI":"10.1016\/j.jacc.2017.03.605","article-title":"Maternal and fetal outcomes of anticoagulation in pregnant women with mechanical heart valves","volume":"69","author":"Steinberg","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"R8-20250924","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1093\/eurheartj\/ehx032","article-title":"Anticoagulation for pregnant women with mechanical heart valves:A systematic review and meta-analysis","volume":"38","author":"D'Souza","year":"2017","journal-title":"Eur Heart J"},{"key":"R9-20250924","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1136\/heartjnl-2014-306500","article-title":"Anticoagulation during pregnancy in women with prosthetic valves:Evidence, guidelines and unanswered questions","volume":"101","author":"Nishimura","year":"2015","journal-title":"Heart"},{"key":"R10-20250924","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"Regitz-Zagrosek","year":"2018","journal-title":"Eur Heart J"},{"key":"R11-20250924","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease:Executive summary:A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"R12-20250924","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.18203\/2320-1770.ijrcog20181935","article-title":"A five year retrospective study on maternal and perinatal outcome in pregnancy after cardiac surgery","volume":"7","author":"Rathore","year":"2018","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"R13-20250924","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1080\/14767050600886666","article-title":"Low-molecular-weight heparin for thromboprophylaxis in pregnant women with mechanical heart valves","volume":"19","author":"James","year":"2006","journal-title":"J Matern Fetal Neonatal Med"},{"key":"R14-20250924","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1177\/1074248414524302","article-title":"Monitoring of anti-Xa in pregnant patients with mechanical prosthetic valves receiving low-molecular-weight heparin:Peak or trough levels?","volume":"19","author":"Goland","year":"2014","journal-title":"J Cardiovasc Pharmacol Ther"}],"container-title":["Journal of Family Medicine and Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_313_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:49:15Z","timestamp":1787068155000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jfmpc.jfmpc_313_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":14,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_313_25","relation":{},"ISSN":["2249-4863","2278-7135"],"issn-type":[{"value":"2249-4863","type":"print"},{"value":"2278-7135","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-02-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}