ACCP Recommendations Pregnant Patients with Mechanical Valves

VTE Prophylaxis:

• Aggressive adjusted-dose UFH throughout pregnancy (2C)

  • Administered q12h and adjusted to keep mid-interval aPTT at least 2X control, or anti-Xa heparin level of 0.35 – 0.7 U/mL

• Adjusted-dose LMWH therapy throughout pregnancy (2C)

  • Dose according to weight to keep a 4hr postinjection anti-Xa level ~1.0 U/mL.

• Either of above until the 13th week, then change to warfarin until the middle of the third trimester, then restart UFH or LMWH (2C)

Resume long-term anticoagulation postpartum with all regimens

Ginsberg et al, CHEST 2001;119(1):122S-129S.

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