Pregnancy anticoagulants

Anticoagulants History of local radiotherapy History of Keloid formation Pregnancy/breast-feeding Heavy smokers... 

Hall JG, Pauli RM, Wilson KM Maternal and fetal sequelae of anticoagulation during pregnancy. AmJ Med 68 122-140, 1980... 

Oral anticoagulants should not be used during pregnancy as they can be the cause of birth defects and abortion. 

Oral anticoagulants are ordinarily contraindicated in the presence of active or past gastrointestinal ulceration thrombocytopenia hepatic or renal disease malignant hypertension recent brain, eye, or spinal cord surgery bacterial endocarditis chronic alcoholism and pregnancy. These agents also should not be prescribed for individuals with physically hazardous occupations. 

Black cohosh may cause nausea, vomiting, hypotension, and even miscarriage. It is absolutely contraindicated in pregnancy. Red clover contains coumarins and should therefore be avoided with anticoagulants. Diets high in red clover isoflavones have reduced livestock fertility and theoretically could do the same in humans. Flaxseed may cause nausea, diarrhea, and flatulence. Cyanogenic nitrates in flax (especially in immature seed pods) have produced toxic reactions. 

Meclofenamate and mefenamic acid (Table 36-1) inhibit both COX and phospholipase A2. Meclofenamate appears to have adverse effects similar to those of other NSAIDs, though diarrhea and abdominal pain may be more common it has no advantages over other NSAIDs. This drug enhances the effect of oral anticoagulants. Meclofenamate is contraindicated in pregnancy its efficacy and safety have not been established for young children. 

When chemotherapeutic mercaptopurines are being given concomitantly with allopurinol, their dosage must be reduced by about 75%. Allopurinol may also increase the effect of cyclophosphamide. Allopurinol inhibits the metabolism of probenecid and oral anticoagulants and may increase hepatic iron concentration. Safety in children and during pregnancy has not been established. 

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