Q: Out of the following, in which condition warfarin can be continued in pregnancy despite its teratogenic risks?

A) Atrial fibrillation
B) Deep Vein Thrombosis (DVT)
C) Pulmonary Embolism (PE)
D) Mechanical valve
E) It is absolutely contraindicated in pregnancy


Answer: D

 Management of anticoagulation in patients with pregnancy is extremely difficult as LMW Heparin or unfractionated Heparin may fail to provide optimum anticoagulation. It requires extensive discussion between mother and a physician, and all options and risks should be conveyed to the mother. Despite its risks of teratogenicity, warfarin is a drug of choice up to week 37 in high-risk patients with mechanical valves. Full discussion of management of anticoagulation of mechanical valves in pregnant patient is out of the scope here, but it requires extensive planning.