Use of Antithrombotic Agents During Pregnancy
Antithrombotic therapy during pregnancy is used for the treatment and prophylaxis of venous thromboembolic disease, for the prevention and treatment of systemic embolism associated with valvular heart disease and/or prosthetic heart valves, and for the prevention of fetal growth retardation and pregnancy loss in patients with antiphospholipid antibodies and in patients with pregnancy-induced hypertension. Flovent inhalers Source Since antithrombotic agents have the potential to produce complications in both mother and fetus, their use during pregnancy raises concerns. Guidelines are difficult to establish because the evidence upon which recommendations are based is derived primarily from level V studies in pregnant patients. This chapter reviews the fetal and maternal effects of antithrombotic agents, including oral anticoagulants, unfractionated heparin, low-molecular-weight heparins (LMWHs), and aspirin, and provides recommendations for their use during pregnancy.
Since our last review, new information has appeared on the use of LMWH during pregnancy, and a placebo-controlled trial of aspirin and prednisone for the prevention of pregnancy loss in women with a history of multiple pregnancy losses and autoantibodies has been published.
Epidemiology of Venous Thromboembolism
The true incidence of venous thromboembolism (VTE) associated with pregnancy is unknown, but there is a strong clinical impression that the risk is increased compared to nonpregnant individuals. Available evidence suggests that postpartum VTE is more common than antepartum VTE and that the risk of VTE is higher after cesarian section than after vaginal delivery.
As in the general population, it is likely that women with congenital deficiencies of antithrombin III, protein C, or protein S, or those with factor V Leiden or the persistent presence of antiphospholipid antibodies have an increased risk of VTE during pregnancy and the puerperium. Women with previous VTE might also have an increased risk of recurrent VTE during pregnancy and the puerpe-rium, but the results are conflicting.