Thrombophilia and anticoagulation in pregnancy: indications, risks and management

Abstract

Objective. Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality in pregnancy and the puerperium. To reduce the incidence of VTE, it is helpful to understand the haemostatic changes during pregnancy and to recognise thrombophilic states. According to the individual risk profile a prophylactic or therapeutic anticoagulation needs to be considered.

Methods. A narrative, non-systematic overview of articles published in English, German or French over the past three decades with an emphasis on manuscripts from 2003 to 2008.

Results. Heparins are the main agents used for anticoagulation during pregnancy. Low-molecular-weight heparins have more advantages than unfractionated heparin and should be preferred. Vitamin-K antagonists are not recommended in this condition as first-line treatment because of the risk for embryopathy and fetal bleeding, but they can be given under certain conditions. Subgroups of patients, such as women with prosthetic heart valves, require special attention. Adverse pregnancy outcomes due to hereditary thrombophilia are new indications for use of anticoagulants during pregnancy.

Conclusions. National and international guidelines on prevention and treatment of thromboembolism are helpful in applying the proper regimen in pregnant women.

Keywords:

• Pregnancy
• anticoagulation
• thrombophilia
• thromboembolism
• thromboprophylaxis
• pregnancy loss