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Anticoagulants may be indicated during pregnancy for the treatment or prophylaxis
of venous thromboembolism and, in patients with mechanical prosthetic cardiac valves,
for the prevention of valve thrombosis and systemic embolisation. Occasionally, anticoagulation
is also indicated in pregnant women with valvular or congenital heart disease.
Maternal mortality statistics highlight pulmonary embolism as a leading cause of maternal
death in the Western world. These statistics, and the increasing understanding of
risk factors for thrombosis, are leading to an increase in usage of anticoagulant
drugs during pregnancy and the puerperium. Knowledge of the basic pharmacology, potential
adverse effects, clinical indications and the special considerations relating to use
of these agents during pregnancy is, therefore, important for obstetricians. Heparin
is the anticoagulant of choice for prevention and treatment of venous thrombosis during
pregnancy, as it does not cross the placenta. Warfarin should generally be avoided
in pregnant women because it crosses the placenta and may give rise to fetal abnormalities.
On the other hand, as the efficacy of heparin in the prevention of systemic embolisation
from prosthetic cardiac valves is still unproven, warfarin remains the anticoagulant
of choice in the middle of pregnancy for such patients.
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© 1996 Pearson Professional Ltd. Published by Elsevier Inc.
