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Mechanical Valve in Pregnancy — EECC MCQ

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ModerateValvular Heart DiseaseMechanical Valve in PregnancyEECC

A 40-year-old woman with a bileaflet mechanical mitral valve replacement is maintained on warfarin with a target INR of 2.5-3.5. She is currently 8 weeks pregnant (unplanned pregnancy). Her INR is 3.0 and her warfarin dose is 4 mg daily. What is the most appropriate anticoagulation management for the first trimester?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Continue warfarin throughout pregnancy if the dose is 5 mg daily or below

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

Per the 2025 ESC Guidelines on CVD in Pregnancy and VHD Guidelines, if the warfarin dose required to maintain therapeutic INR is 5 mg daily or below, continuation throughout pregnancy (including the first trimester) may be considered, as the teratogenic risk is dose-dependent and significantly lower at this dose. If the dose exceeds 5 mg, switching to LMWH with anti-Xa monitoring in the first trimester is recommended. DOACs (C) are contraindicated in pregnancy and with mechanical valves. Stopping anticoagulation (D) is extremely dangerous. IV UFH (E) is for around delivery.

Reference: ESC (2025): Guidelines for the Management of Cardiovascular Disease During Pregnancy