Jun 30, 2017 the use of anticoagulants and thrombolytics in pregnancy is an important consideration. Anticoagulant, thrombolytic, and antiplatelet drugs. Choosing anticoagulant therapies during pregnancy involves a balance of risks and benefits to both the mother and fetus. Pregnancy planning in chronically anticoagulated women 4. The risk further increases if an underlying thrombophilia is present. Management of anticoagulants during pregnancy heart. Pregnancy is associated with changes in haemostasis, including an increase in the majority of clotting factors, a decrease in the quantity of natural anticoagulants and a reduction in. The heparinoid danaparoid orgaran is an lmwh, a combination of heparan, dermatan, and chondroitin sulfate. Several newer anticoagulants can be used in pregnancy table 3. In addition, women receiving chronic anticoagulation who are contemplating pregnancy need counseling regarding how to avoid the potential.
Anticoagulant therapy during pregnancy is indicated for the treatment and prophylaxis of venous thromboembolic disease and for the prevention and treatment. Know the properties of agents that can reverse the actions of heparin and the oral anticoagulants. Be able to describe the biochemical mechanisms of action, therapeutic uses, contraindications and adverse effects of the specific anticoagulant and fibrinolytic agents listed above. Current guidelines advocate 2 anticoagulation strategies. The choice of an anticoagulant requires consideration of maternal risks, potential for teratogenicity, the underlying condition necessitating the treatment, and cost. Guidelines for use of anticoagulation in pregnancy. Warfarin continued throughout pregnancy offers the best thromboembolic protection. Association of anticoagulants in pregnancy 325 thrombotic complications with heparindependent igg antibody that induces thromboxane synthesis and platelet aggregation. Editorial management of anticoagulants during pregnancy. However, the safety of higher doses of aspirin during the first pregnancy is uncertain. Because of the risks to both mother and baby, this is a doubly challenging patient population for the delivery of safe, effective anticoagulation. Unfractionated heparin, low molecular weight heparin, fondaparinux, and warfarin have been studied and employed extensively with direct thrombin inhibitors typically reserved for patients with complications or those requiring intervention.
Management of direct oral anticoagulants in women of. Multiple changes occur to the coagulation system as pregnancy progresses, with the largest changes being seen at term gestation. Anticoagulants remain the primary strategy for the prevention and treatment of thrombosis. A subset of pregnant patients requires anticoagulation during pregnancy andor in the postpartum period, including women at high risk of deep vein thrombosis and women with prosthetic heart valves, atrial fibrillation, cerebral venous sinus thrombosis, left ventricular dysfunction, and some women with fetal loss. These risks may be further increased in the presence of an acquired or inherited thrombophilia.
May 17, 2016 pregnancy outcome was successful with no abnormalities detected on ultrasound scanning during pregnancy or in the infant. This is not the case when the pregnant women has a native valvulopathy in atrial fibrillation, a mechanical prosthesis or a coagulation anomaly. Fortunately, lowmolecularweight heparins lmwhs and unfractionated heparin are quite safe and efficacious when properly selected, dosed, and monitored. Get a printable copy pdf file of the complete article 925k, or click on a page image below to browse page by page. Unfortunately, as discussed above, the use of these agents during pregnancy carries a risk of teratogenicity and toxic fetal effects and increases the risk of pregnancy loss and maternal hemorrhage. The choice of appropriate anticoagulant depends on the stage of pregnancy. Use of anticoagulants during pregnancy and postpartum.
Women requiring anticoagulation need careful attention throughout pregnancy and the postpartum period. Congestion within the pelvic veins from a gravid uterus leads to decreased blood flow to the lower extremities, and compression of the left iliac vein by the right iliac artery is a wellknown phenomenon. Fda classification of drugs for use in pregnancy and breastfeeding fda classification according to risk in pregnancy category a no apparent risks. Safety of anticoagulants in pregnancy and breastfeeding.
The respective indications for heparin and oral anticoagulants reflect their respective advantages and disadvantages for the. Some pregnant women require anticoagulation during pregnancy andor in. May 03, 20 new anticoagulants such as direct factor xa inhibitors and direct thrombin inhibitors have been recently developed, but their experience in pregnancy is limited. Get concise advice on drug therapy, plus unlimited access to ce. Pdf anticoagulants in pregnancy andra james academia. These guidelines focus on the optimal management of anticoagulant drugs for the prevention and treatment of vte following the choice of an anticoagulant. For example, vitamin k antagonists are the most efficacious for preventing mechanical valve thrombosis, but they pose risks to the fetus. Although pregnancy induces a state of hypercoagulability, the thromoboembolic risks during a normal pregnancy are minor. Pharmacists letter includes 12 issues every year, with brief articles about new meds and hot topics. Theyre often called blood thinners, but these medications dont really thin your blood. Current status of anticoagulation in pregnancy the risks associated with oral anticoagulants occur primarily during the second part of the. These drugs are prescribed to patients to treat and prevent a variety of diseases and conditions dvt, pulmonary embolism, blood clot during atrial fibrillation. Pregnancy is associated with a hypercoagulable state. Outside of pregnancy, oral anticoagulants are the mainstay of therapy for patients with mechanical heart valves.
In accordance with the northamerican guidelines american. Anticoagulation during pregnancy ash clinical news. Although warfarin is contraindi possible side effects and complications of therapy to cated during pregnancy, it is not contraindicated manage anticoagulants safely in pregnancy. Fetal and neonatal effects of anticoagulants used in. We aimed to perform an analysis of individual case safety reports retrieved after the standardized meddra query pregnancy and neonatal topics for. The choice of anticoagulant therapy, the degree of monitoring, and the therapeutic target should be modulated by balancing the risks and the benefits to the mother and fetus. Anticoagulants and antiplatelet drugs eliminate or reduce the risk of blood clots. May 10, 2019 we aimed to perform an analysis of individual case safety reports retrieved after the standardized meddra query pregnancy and neonatal topics for which directacting oral anticoagulants. Pregnancy itself is a physiological procoagulant state and increases the risk of thrombosis. Common side effects of these drugs are bruises, diarrhea, fever, intestinal gas, and headache. Anticoagulation for pregnant women with acute deep vein thrombosis dvt or pulmonary embolism pe 5. Venous thromboembolic vte complications are a leading cause of maternal mortality in the developed world.
All major evidencebased guidelines recommend lmwh as the preferred anticoagulant for pregnant women. Many of the available anticoagulant agents may be used safely in pregnancy, but they are disadvantaged by competing efficacy and risks to the mother and fetus. Physiological changes to coagulation during pregnancy pregnancy is associated with changes in haemostasis, including an increase in the majority of clotting factors, a decrease in the quantity of natural anticoagulants and a reduction in. Drugs used to treat anticoagulation during pregnancy the following list of medications are in some way related to, or used in the treatment of this condition. Anticoagulation in pregnant women with artificial heart valves. Prevention of dvtpe during pregnancy and postpartum. Pregnancy is a hypercoagulable state that increases the risk of thromboembolic events. Although aspirin crosses the placenta, it is safe in low doses. Many of the available anticoagulant agents may be used safely. The heparins are a group of anticoagulants that consist of unfractionated heparin, low molecular weight heparins, and heparinoids unfractionated heparin usually just called heparin needs to be given directly into the blood by intravenous iv injection, and inhibits thrombin and factor xa, factors necessary in the final stages of the blood clotting cascade. Anticoagulant therapy during pregnancy is indicated for the treatment and prophylaxis of venous thromboembolic disease and for the prevention and treatment of systemic embolism associated with valvular heart disease andor.
In a study of the transfer of warfarin into breast milk, less than 25 ng warfarin was detected per milliliter 102. The role of anticoagulants in the prevention of pregnancy. This guidance document addresses the use of doacs in women of childbearing potential, with particular focus on the preconceptual period, pregnancy and puerperium, and breast. Occasionally, anticoagulation is also indicated in pregnant women with valvular or congenital heart disease. Unfractionated heparin, low molecular weight heparin, fondaparinux, and warfarin have been studied and. Category c the existence of risks cannot be ruled out.
To reduce the incidence of vte in pregnancy, and improve outcomes, a wider understanding of the risk factors involved and a better identification of women at risk of thrombosis coupled with effective thromboprophylaxis and treatment of vte are required. Feb 01, 2009 prescribing anticoagulants to pregnant women can be difficult and stressful. Anticoagulants acs are commonly used in pregnancy for prevention and management of thrombotic problems. Thrombosis task force 1990 guidelines on oral anticoagulation. Maternal and fetal concerns must be considered at all times, with a careful assessment of the risks and benefits of anticoagulant therapy in each patient. Apr 21, 20 anticoagulants remain the primary strategy for the prevention and treatment of thrombosis. Our practices are largely consistent with guidelines from societies. Thrombophilias have been associated with both maternal and fetal.
Anticoagulants are medicines that keep your blood from clotting, or turning into solid clumps of cells that stick together. Pdf anticoagulants in pregnancy leo brancazio academia. Oral anticoagulants vka and noac guidelines for prescribing. Its worth noting that while evidencebased guideline recommendations for anticoagulation in pregnancy have been published, they are based primarily on observational studies and extrapolation of data from nonpregnant patients. Use of anticoagulants during pregnancy is challenging due to the potential teratogenic effects and dosing complexities of the various agents, and the management of anticoagulation around the time of labor. Novel oral anticoagulants have emerged from clinical development. Use of anticoagulants during pregnancy and postpartum uptodate. Anticoagulant therapy is complex and associated with substantial benefits and risks. Directacting oral anticoagulants doacs in pregnancy. Unfractionated heparin, low molecular weight heparin, fondaparinux, and warfarin have. The use of heparin and oral anticoagulants during pregnancy is problematic because these drugs have the potential to produce adverse effects in the mother and fetus.
1250 1159 820 1305 1561 1484 171 790 40 1392 1044 701 1528 1104 1443 92 885 990 1179 112 154 644 874 240 1167 1034 1120 137 711 269 491 1013 1477 406 391 1168 735 1124 219 236 920 1429 1435