ABSTRACT
Introduction 148 Anticoagulant drugs 148 Heparins and heparinoids 149 Coumarin derivatives (warfarin) 154 Antiplatelet drugs 154
Anticoagulant therapy and breastfeeding 154 Pregnant women with mechanical heart valves 155 Conclusions 155 References 155
Physiologic changes in hemostasis and fibrinolysis, altered blood flow, and venous stasis during pregnancy cause a hypercoagulable state. Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is a common cause of maternal morbidity and mortality in developed countries. Accordingly, the diagnosis, treatment, and prevention of VTE all pose clinically important challenges, because any intervention must take into account the potential for adverse experiences in both the mother and the fetus. Pregnant women with mechanical heart valves and native valvular heart disease can have systemic arterial thromboembolism, which can lead to a devastating outcome, such as a stroke. These women, particularly those with mechanical heart valves, are maintained on long-term warfarin therapy prior to conception, and throughout pregnancy they need effective, ongoing anticoagulation that will not adversely affect the fetus. Finally, antithrombotic therapy is indicated in some women with a past history of VTE to prevent recurrence and, more recently, for the prevention of recurrent pregnancy loss in some women with thrombophilia.
