Vitamin K antagonists usually are contraindicated in pregnancy due to possible harm for the fetus. Has anyone treated a pregnant woman with VKA?
There are a couple of reviews and case reports in literature, but I am rather interested in first hand statements!
sorry, No personal experience with Vitamin K antagonists in pregnancy
I have treated adult patients with complex congenital heart disease or mechanical valves during pregnancy with warfarin. Wait until after 12 weeks to start warfarin (use heparin or LMWH in the first trimester) to avoid the risk of warfarin embryopathy, and change back to heparin or LMWH in the late third trimester if possible. Warfarin will anticoagulate the fetus, so vaginal delivery is contraindicated in patients on warfarin.
Thank you very much, Michael.
When doing this, how closely did you monitor INR values? Did you change the target INR values, for example, if someone was to have INRs of 2 to 3, did you decide not to go higher than maybe an INR of 2.5? Or try to stay as closely to 2 as possible?
Hi Julian.
We used the same INR target as prior to pregnancy for these chronic anticoagulation patients. I don't recall the frequency of monitoring. The cardiologists were very involved in these patients' care as well. They managed the levels for the most part.
Regards,
Mike Stitely
Thank you, Michael. Greetings to NZ! Have done a surgery internship in Middlemore some 10 years ago.