Question

36 weeks pregnant female on warfarin with mitral stenosis. What should we do

• A. Shift to LMW Heparin
• B. Warfarin
• C. Switch to Aspirin
• D. Asprin + heparin

Answer 1

The Correct Option is A

When managing a 36-week pregnant female with mitral stenosis who is on warfarin, it is crucial to prioritize both maternal and fetal safety, especially considering the teratogenic effects of warfarin in pregnancy and the increased risk of bleeding complications. Here's a detailed explanation of the appropriate course of action:

• Warfarin, although effective as an anticoagulant, poses significant risks to the fetus, particularly in the later stages of pregnancy due to potential bleeding issues during delivery.
• Low Molecular Weight Heparin (LMWH) is preferred because it does not cross the placenta, thus eliminating the risk of fetal bleeding or teratogenic effects. It offers effective anticoagulation while being safer for pregnancy compared to warfarin.
• The strategy involves switching from warfarin to LMWH as the term approaches, which is typically around the 36-week mark or earlier to allow for adjustments in dosing and monitoring.
• This transition ensures that anticoagulation is maintained for the mother's condition of mitral stenosis while minimizing risk to the fetus.

Therefore, in this scenario, the correct medical recommendation would be to shift the patient from warfarin to LMW Heparin.