title: Anticoagulation During Pregnancy: Evolving Strategies With a Focus on Mechanical Valves.
abstract: Pregnancy is associated with a hypercoagulable state. Women requiring anticoagulation need careful attention throughout pregnancy and the post-partum period. The choice of anticoagulant therapy, the degree of monitoring, and the therapeutic target should be modulated by balancing the risks and the benefits to the mother and fetus. Many of the available anticoagulant agents may be used safely in pregnancy, but they are disadvantaged by competing efficacy and risks to the mother and fetus. For example, vitamin K antagonists are the most efficacious for preventing mechanical valve thrombosis, but they pose risks to the fetus. Collaborative research that collects patient-level data will help clinicians navigate the intricate process of anticoagulation in pregnancy. Development of anticoagulant agents that are homogeneous, efficacious, safe to the fetus, and not affected by physiological perturbations of pregnancy will have tremendous effect on the outcomes of pregnancy in women who require anticoagulation.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Laith
authors.initials: L
authors.lastname: Alshawabkeh
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Economy
authors.affiliation: Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: anne.valente@cardio.chboston.org.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005333:Fetus / Q000187:drug effects; D006350:Heart Valve Prosthesis; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: factor Xa inhibitors; heart disease; heart valves; heparin; thrombosis; venous thromboembolism