Management Of Pregnant Women With Mechanical Heart Valves

Year 2013, Volume: 10 Issue: 38, 1589 - 1593, 01.04.2013

Aslıhan Küçüker

Abstract

Lifelong anticoagulation is mandatory for patients with mechanical heart valves and oral anticoagulation is the accepted treatment modality worldwide. When these patients become pregnant, oral anticoagulation still needs to be continued. However, oral anticoagulant drugs have known fetal side effects. The possible alternative drugs are standard heparin and low molecular weight heparins, but they may not protect the mechanical heart valve from thrombosis. This situation carries both the phycisian and the patient to a difficult dilemma because every medication has its own risks. Because of the absence of a risk-free medication protecting both the mother and the baby, differing medication protcols have been suggested. The aim of this review is to analyze the literature data to achieve how we can manage this difficult patient group.

Keywords

Pregnancy, mechanical heart valve, anticoagulation

Mekanik Kalp Kapağı Olan Gebe Hastalara Yaklaşım

Abstract

Mekanik kalp kapağı olan tüm hastaların, trombo embolik olayları engellemek için ömür boyu antikoagülan ilaç kullanmaları zorunludur ve günümüzde tüm dünyada kabul gören tedavi şekli oral antikoagülanların kullanımıdır. Bu hastalar gebe kaldığında da antikoagülasyona devam edilmesi şarttır. Ancak oral antikoagülanların bilinen fetal yan etkilerinden ötürü, kullanılmasından kaçınılmaktadır. Elimizde mevcut alternatif ilaçlar standart heparin ve düşük molekül ağırlıklı heparinler olup, bunların da mekanik kapağı trombozdan yeterince korumadığı düşünülmektedir. Bu noktada hekim ve hasta olarak zor bir durumda kalmaktayız çünkü her tedavi seçeneği anne veya bebek için risk taşımaktadır. Her ikisini de koruyacak riskten bağımsız güvenli bir ilaç seçeneği olmadığı için, farklı tedavi protokolleri önerilmiştir. Bu yazının amacı bu zor hasta grubuna yaklaşımı literatür bilgileri ışığında ayrıntılı olarak inceleyerek nasıl bir tedavi şekli izleyeceğimiz konusunda bir fikir oluşturmamıza yardımcı olabilmektir.

Keywords

Gebelik, mekanik kalp kapağı, antikoagülasyon

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