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Pregnancy on mechanical valve

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Shiv

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Mumbai, India
Shiv, from your below post it looks like you were pregnant with a mechanical valve? If so, perhaps you can share your experience? e.g. what was your anticoagulation therapy like?


MVR by On-X in 2019, 29 years old
Yeah. The time i came to know about the pregnancy.. my acitrom was stopped and I too LMWH injections twice a day till 13 weeks I.e 3 months. From 14 weeks to 34 weeks I was back on acitrom +aspirin. After 34 weeks till c section, back to twice a day injections. Baby is well , born on 14th Jan 2021. I am back on acitrom now. Inr 2.1 on 29th anf 2.6 on 31 Jan.. I bought coaguchek both readings from it. I need to confirm with lab too. Will check tomorrow in coaguchek and lab..both.
 

pellicle

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Anyone here who had a pregnancy on mechanical valve? Any experience?
its not a common thing because the vast majority of valvers are over 50 (I think the median age for AVR is in the 60's).

However (like me) quite a number have had AVR at younger ages which means (roughly speaking) half of that are going to be women. So its a small subset. There are some posts here which every time I go to dig them out don't understand why I've not "stashed" the links. Perhaps its because they ceased working when the site migrated to the new software (again)

I'll have a fish but this is a good one to start with:

There is also this older one which has some helpful tips (and a few more links):

From my literature stash I find the following points:

As described in the LOWERING-IT trial, a target INR 1.5 to 2.5 was prescribed. Selected young women achieving this target INR with a warfarin daily dose lower than 5 mg were preferentially offered a third generation mechanical device. When pregnant, such women were kept on the same low-dose sodium warfarin anticoagulation throughout all pregnancy with a weekly INR estimation and joint cardiologic and obstetric monthly evaluations. Cesarean delivery was scheduled before the end of the 37th gestational week. Warfarin therapy was discontinued only 2 days before section and restarted 1 day after surgery. As recently reported, no maternal nor foetal complications were detected in sixteen pregnancies managed by this anticoagulation protocol


I'll follow up when I find those elusive threads
 

pellicle

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I was back on acitrom
I just came back here because I answered your other post ... are you in India? (one of the few places which insists on that drug family) ... I have no knowledge of the effects of that on pregnancy (nor would most of the researchers in developed world) but if you were to hover a little lower in dose that might be helpful

The problem is that determining INR on that junk is hard because it fluctuates your INR too much because the half life of the drug is only 8 hours (vs the 30 or so hours on warfarin or the 5 days on phenprocoumon which is the popular choice in europe).

I think it is only suited to treating DVT
 

Shiv

Well-known member
Joined
Jan 31, 2021
Messages
50
Location
Mumbai, India
I just came back here because I answered your other post ... are you in India? (one of the few places which insists on that drug family) ... I have no knowledge of the effects of that on pregnancy (nor would most of the researchers in developed world) but if you were to hover a little lower in dose that might be helpful

The problem is that determining INR on that junk is hard because it fluctuates your INR too much because the half life of the drug is only 8 hours (vs the 30 or so hours on warfarin or the 5 days on phenprocoumon which is the popular choice in europe).

I think it is only suited to treating DVT
Yes I am from India. I take 3mg acitrom plus 75mg aspirin daily. 3mg acitrom is equal to 6mg warfarin. Will check my INR today. Will post it.
 

Shiv

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Joined
Jan 31, 2021
Messages
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Location
Mumbai, India
its not a common thing because the vast majority of valvers are over 50 (I think the median age for AVR is in the 60's).

However (like me) quite a number have had AVR at younger ages which means (roughly speaking) half of that are going to be women. So its a small subset. There are some posts here which every time I go to dig them out don't understand why I've not "stashed" the links. Perhaps its because they ceased working when the site migrated to the new software (again)

I'll have a fish but this is a good one to start with:

There is also this older one which has some helpful tips (and a few more links):

From my literature stash I find the following points:

As described in the LOWERING-IT trial, a target INR 1.5 to 2.5 was prescribed. Selected young women achieving this target INR with a warfarin daily dose lower than 5 mg were preferentially offered a third generation mechanical device. When pregnant, such women were kept on the same low-dose sodium warfarin anticoagulation throughout all pregnancy with a weekly INR estimation and joint cardiologic and obstetric monthly evaluations. Cesarean delivery was scheduled before the end of the 37th gestational week. Warfarin therapy was discontinued only 2 days before section and restarted 1 day after surgery. As recently reported, no maternal nor foetal complications were detected in sixteen pregnancies managed by this anticoagulation protocol


I'll follow up when I find those elusive threads
Yes in india, most valve patient are 20-30 age due to rheumatic heart disease. Its a big burden.
 

pellicle

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Yes in india, most valve patient are 20-30 age due to rheumatic heart disease. Its a big burden.
indeed that's very interesting (and I guess you mean rheumatic fever, leading to valvular damage leading to heat disease). So you are such? Or were you bicuspid?
 

Shiv

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Mumbai, India
indeed that's very interesting (and I guess you mean rheumatic fever, leading to valvular damage leading to heat disease). So you are such? Or were you bicuspid?
I did the INR on coaguchek xs. It came 3.2. Quite higher than my last 2.6. I see its increasing. It was 2.1 on 29th , 2.6 on 31st and 3.2 on 2nd feb. Please suggest. 1. If should adjust dose now. 2. If yes, how much % decrease. I know people here are quite experienced in this who can help advise me.
 

Shiv

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Joined
Jan 31, 2021
Messages
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Location
Mumbai, India
I did the INR on coaguchek xs. It came 3.2. Quite higher than my last 2.6. I see its increasing. It was 2.1 on 29th , 2.6 on 31st and 3.2 on 2nd feb. Please suggest. 1. If should adjust dose now. 2. If yes, how much % decrease. I know people here are quite experienced in this who can help advise me.
Please note I am on initiation phase and not on regular maintenance dose after my baby delivery. Previous to my baby my usual dose use to be 2mg for 5 days and 2.5 mg for 2 days..along with aspirin.. right now m taking 3 mg daily, no aspirin as of now. It took 8 days for my INR to come 1.8 after baby delivery.. now its increasing. Hope the coaguchek reading is right. If its 3.2 how much variation it can be ? I should assume 3.0 or 3.4? Does it overshoot or underestimate real INR? Or should adjust as per the reading INR I.e 3.2? How you guys do. Thanks in advance. Sorry for such long post and so many questions..I just need the best for me. I can do.
 

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pellicle

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I did the INR on coaguchek xs. It came 3.2. Quite higher than my last 2.6.
this is because of the short half life of the drug you are using. I've tried to help many on that and the answer is basically "that's why its not used in the developed world".

You will be quite unable to get stable doses (I have a friend in Chilie who I've tried to help and he is also a software guy and well educated and he's been unable to ever get the sort of stability that longer half life anticoagulants provide.

You can essentially kiss good bye to being 90% in range on that.
 

pellicle

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..Sorry for such long post and so many questions..I just need the best for me. I can do.
its not a long post and is concise, however I wish I could help but I can't. Do you understand my point about the half life? I can try to clarify it if you like, but unless you change to warfarin you'll only be able to achieve ups and downs
 

carolinemc

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kansas city, mo
sadly nobody here is experienced with that anticoagulant (that has ever stepped forward)
Agreed cause most of us women are usually been having heart problems since childhood, and when we are put in blood thinners(Common in the US is Warfarin(coumadin) after valve replacements, are advise not to birth children due to the chances of birth defects). I was 38 and no children and was settled into the single life. I just have my rescue pup, that are my baby.
 

carolinemc

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kansas city, mo
Please note I am on initiation phase and not on regular maintenance dose after my baby delivery. Previous to my baby my usual dose use to be 2mg for 5 days and 2.5 mg for 2 days..along with aspirin.. right now m taking 3 mg daily, no aspirin as of now. It took 8 days for my INR to come 1.8 after baby delivery.. now its increasing. Hope the coaguchek reading is right. If its 3.2 how much variation it can be ? I should assume 3.0 or 3.4? Does it overshoot or underestimate real INR? Or should adjust as per the reading INR I.e 3.2? How you guys do. Thanks in advance. Sorry for such long post and so many questions..I just need the best for me. I can do.
And diet and active lifestyle makes a difference in INR readings. 3.2 is not high, for the range for blood thinners are 2.5 to 3.5. And you are using what is available to you. Some here are not noticing of where you are from and do not understand that what you are limited to using. Just keep being vigilant and keep watch over your INR numbers. Good luck little mama. Congrats on the baby.
 

Shiv

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Jan 31, 2021
Messages
50
Location
Mumbai, India
And diet and active lifestyle makes a difference in INR readings. 3.2 is not high, for the range for blood thinners are 2.5 to 3.5. And you are using what is available to you. Some here are not noticing of where you are from and do not understand that what you are limited to using. Just keep being vigilant and keep watch over your INR numbers. Good luck little mama. Congrats on the baby.
So sweet of you.
 

dornole

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Jan 5, 2014
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Minnesota, US
Yes in india, most valve patient are 20-30 age due to rheumatic heart disease. Its a big burden.
That’s what I had. Yes very uncommon in US. To the point that I think every medical student and resident in the hospital came to listen to my rheumatic murmur.
 

mina

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Jan 12, 2013
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I had both my children with a mechanical aortic valve. The first was 6 years ago, just about 2 years after the unexpected emergency AVR I had at age 32. The second was 3 years ago.

I saw many specialists before deciding to carry a baby while on anticoagulants. Each had a different approach. We settled on LMWH (2x per day) for the entire pregnancy for each child and non-cesarean delivery. Which approach to take depends on one's comfort level and own situation and medical professionals. In my case, my warfarin dose is very high and I'm very risk adverse, so to eliminate the risk to the fetus using LMWH the entire pregnancy made sense. An entire pregnancy of LMWH is, however, one of the least safest approaches for the mom. And it's not for the faint of heart - those injections hurt. I wouldn't roll those particular dice again - for me it's too risky. I was incredibly fortunate to have two relatively healthy pregnancies, and that's more than I ever thought I'd have when the doctors were telling me I needed immediate surgery and would not be able to carry children if I chose mechanical.

It sounds like you've already had your baby (congratulations!!) - if there's something you're wondering about that you're experiencing, feel free to message me or ask here.
 

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