{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:49:13Z","timestamp":1792259353246,"version":"4.4.0"},"reference-count":45,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Thrombosis is an important cause of morbidity and mortality worldwide. Pregnancy is a hypercoagulable state, and thrombotic complications in pregnancy are a major cause of maternal and fetal morbidity and mortality. Current guidelines support the selective use of aspirin, heparin, and warfarin in pregnant women. The decision to treat with antiplatelets and anticoagulants during pregnancy can be challenging, as these agents have numerous indications and contraindications, potential teratogenicity, and dosing considerations. Their use requires thoughtful discussion between patient and provider that balances therapeutic benefit versus maternal and fetal risks, while accounting for a safe delivery plan. Our aim is to provide a narrative review of the established and emerging indications of antiplatelets and anticoagulants, discuss their appropriate timing of administration, and consider their associated adverse fetal and maternal risks.<\/jats:p>","DOI":"10.3390\/jcm13247757","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T08:04:14Z","timestamp":1734595454000},"page":"7757","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Role of Antiplatelets and Anticoagulation Therapies in Pregnancy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3058-9023","authenticated-orcid":false,"given":"Krista A.","family":"Zachariah","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1314-8693","authenticated-orcid":false,"given":"Su","family":"Yuan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9239-5131","authenticated-orcid":false,"given":"Maria T.","family":"DeSancho","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, Department of Medicine, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inna V.","family":"Landres","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6645-3115","authenticated-orcid":false,"given":"Harsimran S.","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"105547","DOI":"10.1016\/j.phrs.2021.105547","article-title":"Antiplatelet therapy in pregnancy: A systematic review","volume":"168","author":"Nana","year":"2021","journal-title":"Pharmacol. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1161\/CIRCULATIONAHA.114.003902","article-title":"Cardiovascular Management in Pregnancy: Antithrombotic Agents and Antiplatelet Agents","volume":"132","author":"Yarrington","year":"2015","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1016\/j.jacc.2016.06.076","article-title":"Anticoagulation During Pregnancy: Evolving Strategies with a Focus on Mechanical Valves","volume":"68","author":"Alshawabkeh","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1182\/asheducation-2009.1.277","article-title":"Pregnancy-associated thrombosis","volume":"2009","author":"James","year":"2009","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/AOG.0000000000002708","article-title":"ACOG Committee Opinion No. 743: Low-Dose Aspirin Use During Pregnancy","volume":"132","author":"Porter","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1161\/01.CIR.0000063575.17904.4E","article-title":"American Heart Association\/American College of Cardiology Foundation guide to warfarin therapy","volume":"107","author":"Hirsh","year":"2003","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/AOG.0000000000002706","article-title":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2014Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy","volume":"132","author":"James","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_8","unstructured":"Writing Committee Members, Otto, C.M., Nishimura, R.A., Bonow, R.O., Carabello, B.A., Erwin, J.P., Gentile, F., Jneid, H., Krieger, E.V., and Mack, M. (2021). 2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol., 77, e25\u2013e197."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s11239-015-1309-0","article-title":"Guidance for the treatment and prevention of obstetric-associated venous thromboembolism","volume":"41","author":"Bates","year":"2016","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1056\/NEJM199709043371002","article-title":"A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l\u2019Embolie Pulmonaire","volume":"337","author":"Simonneau","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1177\/1074248414524302","article-title":"Monitoring of anti-Xa in pregnant patients with mechanical prosthetic valves receiving low-molecular-weight heparin: Peak or trough levels?","volume":"19","author":"Goland","year":"2014","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e017559","DOI":"10.1161\/JAHA.120.017559","article-title":"Direct Oral Anticoagulant Use: A Practical Guide to Common Clinical Challenges","volume":"9","author":"Chen","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1161\/STROKEAHA.120.028825","article-title":"Comparative Safety and Effectiveness of Oral Anticoagulants in Nonvalvular Atrial Fibrillation: The NAXOS Study","volume":"51","author":"Danchin","year":"2020","journal-title":"Stroke"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.23736\/S2724-5683.24.06546-3","article-title":"Italian Registry in the Setting of Atrial Fibrillation Ablation with Rivaroxaban\u2014IRIS","volume":"72","author":"Lavalle","year":"2024","journal-title":"Minerva Cardiol. Angiol."},{"key":"ref_15","first-page":"100202","article-title":"Anticoagulation of women with congenital heart disease during pregnancy","volume":"5","author":"Rutz","year":"2021","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/jth.15217","article-title":"Monitoring of anticoagulation in thrombotic antiphospholipid syndrome","volume":"19","author":"Cohen","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e884","DOI":"10.1016\/S2352-3026(20)30327-6","article-title":"Safety of direct oral anticoagulant exposure during pregnancy: A retrospective cohort study","volume":"7","author":"Tittl","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Demuth, B., Pellan, A., Boutin, A., Bujold, E., and Ghesqui\u00e8re, L. (2024). Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13041022"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1097\/HJH.0000000000003739","article-title":"Management of hypertensive disorders in pregnancy: A Position Statement of the European Society of Hypertension Working Group \u2018Hypertension in Women\u2019","volume":"42","author":"Thomopoulos","year":"2024","journal-title":"J. Hypertens."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ijgo.12802","article-title":"The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention","volume":"145","author":"Poon","year":"2019","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"US Preventive Services Task Force, Davidson, K.W., Barry, M.J., Mangione, C.M., Cabana, M., Caughey, A.B., Davis, E.M., Donahue, K.E., Doubeni, C.A., and Kubik, M. (2021). Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: US Preventive Services Task Force Recommendation Statement. JAMA, 326, 1186\u20131191.","DOI":"10.1001\/jama.2021.14781"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/j.jacc.2021.02.026","article-title":"Management of Women with Congenital or Inherited Cardiovascular Disease from Pre-Conception Through Pregnancy and Postpartum: JACC Focus Seminar 2\/5","volume":"77","author":"Lindley","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e008687","DOI":"10.1161\/CIRCINTERVENTIONS.120.008687","article-title":"Pregnancy-Associated Myocardial Infarction: Prevalence, Causes, and Interventional Management","volume":"13","author":"Tweet","year":"2020","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_24","unstructured":"Zaidi, S.R.H., and Jenkins, S.M. (2024, November 12). Anticoagulant Therapy in Pregnancy, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK606098\/."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Schrufer-Poland, T.L., Florio, K., Grodzinsky, A., Borsa, J.J., and Schmidt, L. (2022). Management of May Thurner Syndrome in Pregnant Patients. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9120410"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1521-6926(02)00100-7","article-title":"Arterial thromboembolism in pregnancy","volume":"16","author":"Walker","year":"2003","journal-title":"Best Pract. Res. Clin. Haematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1182\/bloodadvances.2018024802","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy","volume":"2","author":"Bates","year":"2018","journal-title":"Blood Adv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1136\/annrheumdis-2019-215213","article-title":"EULAR recommendations for the management of antiphospholipid syndrome in adults","volume":"78","author":"Tektonidou","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e000712","DOI":"10.1161\/JAHA.113.000712","article-title":"Pregnancy complicated by valvular heart disease: An update","volume":"3","author":"Nanna","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100119","DOI":"10.1016\/j.shj.2022.100119","article-title":"The Natural History of Bicuspid Aortic Valve Disease","volume":"7","author":"Kusner","year":"2022","journal-title":"Struct. Heart"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/CIRCULATIONAHA.115.015242","article-title":"Pregnancy in Women with a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC)","volume":"132","author":"Ruys","year":"2015","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1161\/CIRCULATIONAHA.115.017349","article-title":"Mechanical Heart Valves in Pregnancy: A Sticky Business","volume":"132","author":"Economy","year":"2015","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.1161\/CIR.0000000000000458","article-title":"Management of Pregnancy in Patients with Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association","volume":"135","author":"Canobbio","year":"2017","journal-title":"Circulation"},{"key":"ref_34","unstructured":"American College of Cardiology (2024, November 12). (18 May 2015). Anticoagulation for Valvular Heart Disease. Available online: https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2015\/05\/18\/09\/58\/anticoagulation-for-valvular-heart-disease."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.21037\/cdt-20-631","article-title":"Anticoagulation management in adult patients with congenital heart disease: A narrative review","volume":"11","author":"Sinning","year":"2021","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.jacc.2017.12.054","article-title":"Clinical Outcomes in Adolescents and Adults After the Fontan Procedure","volume":"71","author":"Dennis","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1136\/heartjnl-2015-307467","article-title":"The Fontan circulation after 45\u2005years: Update in physiology","volume":"102","author":"Gewillig","year":"2016","journal-title":"Heart"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1017\/S1047951124000489","article-title":"Detection of occult thrombosis in individuals with Fontan circulation by cardiac MRI","volume":"34","author":"Curtis","year":"2024","journal-title":"Cardiol. Young"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.jacc.2022.10.037","article-title":"Thromboprophylaxis in Patients with Fontan Circulation","volume":"81","author":"Possner","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e004575","DOI":"10.1161\/CIRCOUTCOMES.117.004575","article-title":"Pregnancy in Women with a Fontan Circulation: A Systematic Review of the Literature","volume":"11","author":"Baskar","year":"2018","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1161\/01.cir.0000437597.44550.5d","article-title":"Diagnosis and treatment of fetal cardiac disease: A scientific statement from the American Heart Association","volume":"129","author":"Donofrio","year":"2014","journal-title":"Circulation"},{"key":"ref_42","first-page":"100257","article-title":"Management of Fontan circulation in pregnancy: A multidisciplinary approach to care","volume":"3","author":"Wolfe","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Samfireag, M., Potre, C., Potre, O., Tudor, R., Hoinoiu, T., and Anghel, A. (2022). Approach to Thrombophilia in Pregnancy-A Narrative Review. Medicina, 58.","DOI":"10.3390\/medicina58050692"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2014Obstetrics (2018). ACOG Practice Bulletin No. 197: Inherited Thrombophilias in Pregnancy. Obstet. Gynecol., 132, e18\u2013e34.","DOI":"10.1097\/AOG.0000000000002703"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1016\/S0140-6736(22)02128-6","article-title":"Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): An open-label, multicentre, randomised, controlled trial","volume":"400","author":"Bistervels","year":"2022","journal-title":"Lancet"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7757\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:34Z","timestamp":1760115334000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":45,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247757"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247757","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,19]]}}}