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Anticoagulants during pregnancy.

J S Ginsberg¹, J Hirsh

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Annual Review of Medicine

|January 1, 1989

Summary

Heparin is the preferred anticoagulant for pregnant patients with venous thromboembolic disease due to its established safety and efficacy for both mother and fetus. For prosthetic heart valves, adjusted-dose heparin or combined therapy may be necessary.

Area of Science:

Obstetrics and Gynecology
Cardiology
Pharmacology

Background:

Anticoagulant therapy during pregnancy presents significant risks to both mother and fetus.
Both heparin and oral anticoagulants have potential adverse effects.
Existing literature highlights the differential safety profiles of anticoagulants in pregnancy.

Purpose of the Study:

To review the literature on anticoagulant use in pregnancy.
To determine the preferred anticoagulant for venous thromboembolic disease prophylaxis and treatment in pregnant patients.
To identify optimal anticoagulation strategies for pregnant patients with prosthetic heart valves.

Main Methods:

Literature review of studies on anticoagulant therapy in pregnancy.
Analysis of maternal and fetal outcomes associated with heparin and oral anticoagulants.

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Evaluation of established efficacy and safety data for different anticoagulants.

Main Results:

Heparin demonstrates a superior safety profile for the fetus compared to oral anticoagulants.
Heparin is established as the preferred anticoagulant for venous thromboembolic disease in pregnancy.
The efficacy of heparin alone in preventing systemic embolism in prosthetic heart valve patients is not definitively established.

Conclusions:

Heparin is the recommended anticoagulant for venous thromboembolic disease in pregnant individuals.
For pregnant patients with prosthetic heart valves, adjusted-dose heparin or a combination of heparin and oral anticoagulants should be considered.
Careful consideration of risks and benefits is crucial when selecting anticoagulation strategies during pregnancy.