[Anticoagulant treatment in women during pregnancy, at childbirth and during puerperium--safety and effectiveness].

Pregnancy and puerperium, defined as the first 6 weeks after childbirth, represent physiological prothrombotic states that result in increased risk of venous thromboembolism with the highest prevalence during puerperium and valve thrombosis in women with implanted cardiac prosthesis. The use of vitamin K antagonists, heparins, or any combination of these agents, especially in women following heart valve implantation, has potentially adverse outcomes for the mother and fetus, largely related to thrombotic or hemorrhagic complications. There is agreement that failures in anticoagulation on obstetrical patients are most often due to underdosing and the lack of appropriate laboratory monitoring. This review summarizes the current data on anticoagulant therapy in pregnant women with the emphasis placed on practical implications and clinical practice guidelines.