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Mechanical Valve Neuraxial Safety — FRCA Final MCQ

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HardObstetric AnaesthesiaMechanical Valve Neuraxial SafetyFRCA Final

Parturient on warfarin for mechanical mitral valve, INR 2.8 at 37 weeks. Neuraxial approach?

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Correct answer: D — Stop warfarin, bridge LMWH, stop LMWH 24h before, check INR <1.5 and anti-Xa

Mechanical valve: stop warfarin, bridge with LMWH, stop LMWH ≥24h (prophylactic)/24-36h (therapeutic) before neuraxial. Check INR <1.5 AND anti-Xa levels. Requires haematology and cardiology input. Planned delivery.

Reference: ESRA – 2022 – Neuraxial and anticoagulation; RCOG – 2022 – Mechanical valves in pregnancy