Anticoagulation Therapy in Pregnant Patients

  • Steven A. Savella
  • Jessica A. Kvasic
  • Joe F. Lau
Chapter

Abstract

Pregnancy is an acquired hypercoagulable state. During pregnancy, there are increases in clotting factors and fibrinogen, coupled with decreases in fibrinolytic activity and endogenous anticoagulants such as protein S. The intricate balance that normally exists between endogenous anticoagulant and procoagulant factors may become disrupted, potentially leading to venous thromboembolism (VTE) affecting the mother or gestational complications involving the fetus. VTE has remained an important cause of mortality and morbidity in the pregnant patient, with pulmonary embolism (PE) as the leading cause of mortality. Moreover, in susceptible mothers with certain hypercoagulable conditions, the fetus may be subject to gestational complications that include preeclampsia, intrauterine growth restriction, and fetal loss.

The management of anticoagulation therapy during pregnancy can be challenging, particularly because anticoagulants such as the vitamin K antagonists like warfarin can cross the placenta and are associated with teratogenesis leading to congenital abnormalities, miscarriage, and fetal bleeding. Insufficient evidence currently exists on the use of direct oral anticoagulants (DOACs), so they are not recommended by current guidelines. Because negatively charged heparin molecules do not cross the placenta, low-molecular-weight heparins (LMWHs) are the preferred treatment for prophylaxis and treatment of VTE during pregnancy. In this chapter, the management of anticoagulation therapy for the pregnant patient will be reviewed.

Keywords

Thromboembolism Anticoagulation Deep vein thrombosis Heparin Prophylaxis Pulmonary embolism Treatment Warfarin Thrombophilia Low-molecular-weight heparin 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Steven A. Savella
    • 1
  • Jessica A. Kvasic
    • 2
  • Joe F. Lau
    • 3
  1. 1.Department of CardiologyZucker School of Medicine at Hofstra/Northwell, Northwell HealthManhassetUSA
  2. 2.Department of MedicineZucker School of Medicine at Hofstra/Northwell, Northwell HealthManhassetUSA
  3. 3.Department of CardiologyZucker School of Medicine at Hofstra/NorthwellNorthwell Health, ManhassetUSA

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