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Anticoagulation in Pregnancy - DR Vivek Pillai
Anticoagulation in Pregnancy - DR Vivek Pillai
Anticoagulation in Pregnancy - DR Vivek Pillai
PREGNANCY
DR VIVEK PILLAI
PATHOPHYSIOLOGY
• Normal pregnancy is associated with a
hypercoagulable state due to increased serum
levels of procoagulants, such as factor
II, VII,VIII, X, XII and fibrinogen.
• In addition, protein S levels ↓ during
pregnancy,and increased resistance to
activated protein C is observed in the second
and third trimesters of pregnancy.
• Serum plasminogen activator inhibitor-1 (PAI-
1) and placental plasminogen activator
inhibitor-2 (PAI-2) increase with pregnancy
which leads to a decreased fibrinolytic state .
• Venous stasis resulting from pressure of the
gravid uterus on the inferior vena cava and
decreased venous tone are additional
predisposing factors to VTE.
SITUATIONS WARRANTING ANTICOAG.
IN PREGNANCY
• VTE.
• For prevention and treatment of systemic
embolism in patients with mechanical heart
valves.
• In combination with aspirin, for prevention of
recurrent fetal losses in women with APLAS.
• Pregnancy is associated with 4 times increased risk of
venous thromboembolism (VTE) and the risk
increases to 14-fold during puerperium.
• This risk further increases if an underlying
thrombophilia is present.
• PE remains a leading cause of maternal mortality in
the Western world.
• The risk in pregnant women is 5 times higher than in
non pregnant women of the same age.
• Venous Thromboembolism,
Thrombophilia,Antithrombotic Therapy, and
Pregnancy
• ACCP Evidence- Based Clinical Practice
Guidelines (8th Edition)
• Chest 2008;133;844S-886S
GLOSSARY
Prophylactic UFH: UFH 5,000 U subcutaneously q12h.