Pregnancy and Anticoagulation: What Is a Clinician to Do?

Caring for pregnant women who require anticoagulation therapy is a major clinical challenge. Warfarin is associated with increased rates of birth defects and fetal loss, so many clinicians are turning to newer, less well-studied anticoagulants. To assess maternal and fetal outcomes after enoxaparin treatment, investigators at two New Zealand tertiary referral hospitals retrospectively studied 31 expectant mothers with prosthetic heart valves.

Between January 1997 and July 2008, enoxaparin (1 mg/kg twice daily) was used during 47 pregnancies, 39 of which exceeded 12 weeks' gestation. In 34 pregnancies (72%), the women received enoxaparin throughout pregnancy; in the rest, the women received enoxaparin during the first 12 weeks, the last two w…