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The article by Ginsberg and colleagues¹ further supports the use of low-molecular-weight heparin (LMWH) in pregnant women with mechanical heart valves. In their work, the authors describe the clinical problem of anticoagulation in this situation and highlight possible management strategies with LMWH owing to superior pharmacologic properties and lower potential adverse effects compared with other therapeutic modalities.

Since Ginsberg and colleagues could only provide data of a very small number of patients with mechanical heart valve prostheses treated with LMWH, we would like to add our observations and refer to our recent report² (Table 1) on 7 pregnant women treated with therapeutic doses of LMWH and antifactor Xa monitoring (target range antifactor Xa, 0.5.-1.2 IU/mL; blood collected 3-4 hours after injection). Besides 1 minor bleeding event in this small group of patients, this treatment regimen appeared safe and efficacious.

Table appears in full text version. Patient Data

We suggest that in contrast to the . . . [Full Text of this Article]

Rupert Bauersachs, MD
Darmstadt, Germany

E. Lindhoff-Last, MD
Frankfurt, Germany