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Pregnancy and the puerperium are well-established risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE), which are collectively referred to as venous thromboembolic disease (VTE). Treatment of VTE in pregnant patients is unique in several ways. (See 'Use of anticoagulants during pregnancy and postpartum'.)

Warfarin should be avoided, particularly in the first trimester, because it may be teratogenic.

Fondaparinux, a synthetic heparin pentasaccharide, is generally avoided due to a paucity of safety data during pregnancy, with the only potential indication in the setting of heparin-induced thrombocytopenia (HIT).

The direct oral anticoagulants, which include the oral direct thrombin inhibitors and the factor Xa inhibitors, should be avoided due to insufficient information about their safety when used during pregnancy.

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Monitoring of anticoagulant activity tends to be more vigilant because less is known about the appropriate dosing of anticoagulants during pregnancy.

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Literature review current through: Dec 2020. This topic last updated: Sep 19, 2019.

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