Anticoagulants in pregnancy.

Pregnancy is associated with a prethrombotic state. Pulmonary embolism is the major cause of maternal mortality. Anticoagulant prophylaxis and therapy are therefore commonplace in pregnant women. Those with inherited and acquired thrombophilic conditions are at increased risk and special considerations arise in management. Heparin has recently become the favoured anticoagulant drug in pregnancy. Its use carries risks of osteopaenia and thrombocytopaenia, as well as haemorrhage, in the mother. Warfarin is teratogenic and may also cause haemorrhagic complications in mother and fetus. Few clinical trial data exists for guidance on optimal anticoagulant regimes during pregnancy and the puerperium and details of management will depend upon the personal preferences of patient and clinician, after due consideration of the perceived risks and benefits in the individual clinical situation.