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The treatment of pregnant women with venous thromboembolism (VTE) is challenging, given concerns that anticoagulants can provoke maternal bleeding and have untoward effects on fetuses. Further, invasive procedures such as epidural anesthesia and cesarean delivery are problematic in patients who receive anticoagulants. Beyond these concerns, uncertainties remain about which antithrombotic drugs are safest and most effective, as well as optimal dosages and schedules.
Regarding the choice of anticoagulants, the authors of a recent review article note that risks for fetal embryopathy and bleeding preclude use of coumarins during pregnancy. Low-molecular-weight heparins (LMWHs) have largely supplanted unfractionated heparin (UH) because LMWHs are…