Anticoagulant therapy in pregnancy: Indications and strategies.

Anticoagulant therapy is sometimes required during pregnancy either for the prevention of thromboembolic disease, for patients already on long-term an ti-thrombotic treatment (for valvular prostheses) or for the prevention of complications of risk factors such as hereditary or acquired thrombophilia. Pregnancy is in itself a hyper-coagulable condition and the risk of thrombo embolic complications is raised. Anticoagulation is a risk to the mother an d to the foetus, and the management (heparin or vitamin K antagonists. resp ective doses) must be adapted to the underlying pathology and the stage of pregnancy. Mechanical valve prostheses are the most difficult problem and d ifferent strategies are proposed. The use of low molecular weight heparin may improve the outcome of these pa tients, but further trials are necessary.