Managementul tratamentului anticoagulant la gravidele cu valvă mecanică cardiacă.

Introduction. The management of pregnant women with cardiac mechanical valves represents a real medical challenge, since the anticoagulant used must not cross the fetal-placental barrier, in order to avoid its teratogenic effect or the appearance of hemorrhages at the fetal level. Anticoagulants available for management include: vitamin K antagonists, unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Case presentation. A IIIG IIIP, at 37 weeks of gestation, with twin bichorial pregnancy, the first fetus - pelvic presentation, the second fetus - transverse presentation, with intact membranes, pregnancy cholestasis, double scar uterus, heart valve prosthesis, DSA, chronic venous insufficiency, under chronic anticoagulant treatment with Clexane® 80 mg x 2/day, was admitted for non-systemic uterine contractions. With 36 hours before the intervention, the Clexane® is replaced by HNF with aPTT taken at five hours, and stopped with five hours before the intervention, resuming it five hours postoperatively. Favorable evolution after caesarean intervention, but on the fifth day after birth, the presence of a subperitoneal subaponevrotic hematoma is established. After the reintervention, Clexane® 0.6 ml x 2/day is decided, with a favorable evolution, without the need for a surgical reintervention. Conclusions. Until the 38th week, LMWH is administered. This can be replaced with warfarin from S13-S36. At birth, warfarin should be replaced with LMWH or UFH due to the severe risk of bleeding. LMWH (atiXa) and UFH (aPTT) should be stopped 24 hours before birth is scheduled. The normalization of fetal INR takes longer than the maternal one. Postpartum rapid reintroduction of maternal anticoagulant therapy may lead to a major risk of bleeding. [ABSTRACT FROM AUTHOR]