In pregnant women with a mechanical valve prosthesis, anticoagulation therapy is challenging because of the risk of embryopathy with vitamin K antagonists (VKA's), while unfractioned heparin and low molecular weight heparin (LMWH) are associated with a higher risk of valve thrombosis [1]. The presence of a mechanical valves is a multivariate predictor for adverse pregnancy outcome in women with heart disease [2]. This article describes and motivates the advices concerning anticoagulation for these women as formulated in the 2011 version of the Guidelines on the management of cardiovascular diseases of the European Society of Cardiology [3]. VKA's are the safest option to prevent valve thrombosis. Since the risk of embryopathy is low when daily dose requirements of VKA's are low, continuation of VKA's throughout pregnancy should be considered. When dose requirements of VKA's are higher, the risk of embryopathy is higher. Therefore it should be considered to substitute VKA's with LMWH during the first trimester. When LMWH are given, anti-factor Xa level monitoring is of vital importance. During the second and third trimester, VKA's are recommended until the 36 week of pregnancy.
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