Development of National Anticoagulation Guidelines for Pregnant Women with Mechanical Heart Valves in Rwanda

Emmanuel Rusingiza, Vongai Mlambo, Nicole Schulick, David Ntirushwa, Helen Mucyo, Esubalew Woldeyes Asfaw, Diomede Ntasumbumuyange, Sandra Havyarimana, Evariste Ntaganda, Ceeya Bolman, Yihan Lin

Abstract

Background: The number of Rwandan women of reproductive age receiving mechanical heart valve prostheses for rheumatic heart disease is increasing. Effective anticoagulation management during pregnancy is essential to prevent valve thrombosis but poses significant risks to both mother and foetus if not carefully tailored.
Objective: This article describes the multidisciplinary development of national guidelines for anticoagulation management in pregnant women with mechanical heart valves in Rwanda, integrating local clinical realities with international best practices.
Methods: Guideline development involved a three-stage process: (1) a stakeholder workshop to assess current practices and challenges, (2) iterative drafting and feedback from clinicians and policymakers, and (3) validation by representatives from key medical specialties. The process incorporated evidence from local studies, international guidelines, and the lived experiences of patients and providers.
Results: The resulting guidelines emphasise preconception counselling, individualised risk assessment, and clear algorithms for adjusting anticoagulation regimens by gestational age. Practical considerations such as medication availability, laboratory capacity, and provider training are addressed to ensure feasibility in low-resource settings.
Conclusion: These national guidelines aim to standardise anticoagulation management for pregnant women with mechanical heart valves in Rwanda, improving maternal and foetal outcomes. The approach provides a model for adapting evidence-based care to resource-limited environments.