Recetved:2 January 2023Accepted:17 March 2023D0L:10.1111/h.18781BJHaemGUIDELINEBritish Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanicalheart valvesWill Lester'Niki Walker2 Kailash Bhatia Etienne CiantarAnita Banerjee'Joanna Trinders Julia Anderson?Kenneth Hodson Lorna Swan2Charlotte Bradbury,10 Juliette Websterl1 Clare Tower2Centre for Clinical Haematology.University Hospitals Birmingham NHS Foundation Trust,Birmingham,UKDepartment of Cardiology.Golden Jubilee National Hospital West of Scotland Regional Heart andLung Centre.Clydebank.UKDepar tment of Anaesthetics.Manchester University NHS Foundation Trust.Manchester.UKDepartment of Obstetrics&Gynaecology.Leeds Teaching Hospitals NHS Trust.Leeds.UKSDepartment of Obstetric Medicine,Women's Services,Guy's and St Thomas'Hospitals NHS Foundation Trust,London,EnglandDepartment ofObstetrics.University Hospitals Bristol NHS Foundation Trust,Bristol,UKDepartment of Haematology,NHS Lothian,Edinburgh.UKDepar tment of Maternity.Newcastle Upon Tyne Hospitals NHS Foundation Trust,Newcastle Upon Tyne,UKCellular and Molecular Medicine.University of Bristol Bristol,UKBristol Haematology and Oncology Centre.Bristol.UKDepartment of Maternity.Birmingham Women's and Chikdren's NHS Foundation Trust,Birmingham.UKDepartment ofObstetric and Maternal and Fetal Medicine,Manchester University NHS Foundation Trust,Manchester,UKCorrespondenceWill Lester,Centre for ClinicalHaematology.University Hospitals Birmingham NHS Foundat ion Trust,Edgbaston,Birming ham B152TH,UK.Email:will.lester@uhb.nhs.ukKeywords:anticoagulation,embryopathy,mechanical heart valve,pregnancyINTRODUCTIONRECOMMENDATIONSEvidence is limited regarding the prevalence and optimalIndividuals with a MHV of childbearing age should bemanagement of pregnancy in individuals with mechanicaloffered pre-pregnancy counselling as soon as appropriateheart valves (MHVs).Studies are scarce,often with small(Grade 1D).numbers of patients included.Mechanical valve thrombo-Prior to cardiac surgery,all individuals of childbearingsis (MVT)occurs more frequently in pregnancy and thereage should be counselled about the impact of valve re-is a high risk of postpartum haemorrhage (PPH).Thereplacement choice on future pregnancy risk(Grade 1D).are a number of options for anticoagulation with differingIndividuals with MHV who are pregnant should be man-risks to the pregnant individual and foetus.In the absenceaged in a designated specialist centre with an experiencedof high-quality data,this guideline aims to give recommen-multidisciplinary team(MDT)including obstetrics,car-dations using observational data,evidence from outside ofdiology,cardiac surgery,anaesthetics,neonatology andpregnancy and expert opinion to address the key risks at dif-haematology(Grade 2C).ferent stages during pregnancy,at delivery and postpartum.Anticoagulation options,including risks and benefits toAlthough no single strategy for anticoagulation can be rec-the
