Anticoagulation during pregnancy

Anticoagulation of a pregnant woman is a complex issue for both the treating physician and the patient. In patients with mechanical prosthetic valves, long-term anticoagulation is mandatory to prevent thromboembolic complications; and in those with thrombophilic disorders and history of thromboembolism, anticoagulation is strongly indicated. With an increase in the number of patients with prosthetic heart valves, as well as the increase in maternal age, the issue of anticoagulation has become a very important one. Despite the widespread use of warfarin and unfractionated heparin during pregnancy, the optimal use of anticoagulants during pregnancy remains controversial because of a lack of appropriate prospective randomized clinical trials. In fact, even retrospective data on heparin provide miserably inadequate information for those making a decision on the correct dosing regimen. More recently, low molecular weight heparin has been proposed as a safer method of anticoagulation. This review summarizes current data and recommendations on anticoagulation during pregnancy.