What is the role of anticoagulants and antiplatelet medications in the treatment of stroke during pregnancy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

The major categories of medications used in stroke prophylaxis are anticoagulants and antiplatelet agents. Their safety profiles during pregnancy vary as follows:

Heparin is routinely used during pregnancy when anticoagulation is needed because it does not cross the placenta. It takes effect quickly and can be stopped abruptly. Associated risks and adverse reactions include heparin-induced thrombocytopenia, osteoporosis (with the use of low-molecular-weight heparin or unfractionated heparin), and bleeding.

Warfarin crosses the placenta and can cause complications with organogenesis (ie, during weeks 6-12 of gestation). Maternal-fetal bleeding can occur with warfarin, as can spontaneous abortions and stillbirths.

Aspirin can result in fetal complications if given for prolonged periods in high doses; therefore, it is not used for long-term treatment with an antithrombotic agent in pregnancy. Adverse events appear to be dose-related; hence, studies have used a low dose (60 mg), which was not strongly associated with pregnancy-related complications.

Use of clopidogrel in human pregnancies has not been adequately studied. Dipyridamole is also a category B drug in pregnancy. Dipyridamole has not caused clinically significant teratogenic effects in animals when given in moderate doses; further studies of its safety must be performed. The aspirin-dipyridamole combination has limited use in pregnancy because of the adverse effects of aspirin. [72, 75]


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