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Use of mechanical heart valves generally requires anticoagulation with coumarin or heparin derivatives and is associated with higher maternal and fetal complication rates during pregnancy. Because fetal complications may be related to warfarin dose, Italian investigators conducted an observational study of a preoperative counseling protocol for women with valvular heart disease who planned to become pregnant. The protocol included a trial to determine the warfarin dose required to achieve target international normalized ratios (INRs; 1.5–2.5 for aortic valves) for use with newer, presumably less thrombogenic, prosthetic valves. Cesarean delivery was planned to minimize fetal intracranial bleeding.
Of 40 participants, 22 required aortic or mi…