Thursday, 24. of July 2014
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Pregnancy under anticoagulation therapy – a high risk?

Many female patients with severe forms of thrombophilia (a hypercoagulable state due to hereditary and acquired factors) are today on long-term oral anticoagulation with warfarin or, in Germany, with phenprocoumon. “Advisory information for women of childbearing age is necessary,” said Hannelore Rott, MD, MVZ-Lab, Duisburg, Germany. “Two months’ time is the optimal interval between last use of Vitamin-K-Antagonists and conception”.The use of low molecular weight heparins (LMWH) makes a safe pregnancy possible even in patients with severe thrombophilia. International guidelines endorse the use of LMWH for both treatment and prophylaxis in pregnancy. The advantages of LMWH over unfractionated heparins include a reduced bleeding risk, a longer half life, a higher bioavailability, a minimal risk of heparin-induced thrombocytopenia, a much lower risk of osteoporosis, and no need for monitoring except in patients with renal insufficiency. Rott stated: “Usually, a spontaneous delivery is possible under medication with LMWH because the bleeding risk is not higher in pregnant women on prophylaxis with LMWH in comparison to women without LMWH prophylaxis. It’s important to discontinue LMWH injection for regional anaesthesia during labor for 12–24 hours depending on the dose of LMWH.” Post-partum, the prophylaxis with low molecular heparin is continued during the time of breast-feeding, or can be changed to warfarin, which is not secreted in the breast milk.“According to our experience, it is early enough to stop anticoagulation before the 6th week of gestation to prevent warfarin-embryopathia”, said Rott, “If a patient becomes pregnant under oral anticoagulation, stop warfarin immediately and administer a high dose of oral vitamin K (10 mg/day) for a week, and immediately switch to low molecular weight heparin, which does not cross the placenta.”

Report by Thomas Klein, MD, MSc (Nov. 2009)