Thrombo Prophylaxis in Preg : What options we have and drug of choice as per gestation

Thrombo Prophylaxis in Preg : What options we have and drug  of choice as per gestation .

Drugs are preg 1) Warfarin ( 12 weeks to 36 weeks).2)  Crude Heparin C) LMWH D) Aspirin –this drug is only  when  the probality of VTE is less

ABC of Warfarin:Trade name (Brand in India) : ACTINORM( 1/2/3 mg):- If initiated prior to pregnancy then the dictum is to  stop the said drug(warfarin)  2 weeks after missed period in apprehension of warfarin embryopathy.  However may commence again when embryogenesis is complete (from 14 weeks if poor) if LMWH is unaffordable . If this rule is not followed than there is a real risk of  Warfarin embryopathy which akin the risk induced by Hydantain therapy, Varicella infn ,  or alcohol intake or say uncontrolled DM. Therefore in early pregancy (during embryogenesis) we should be cautious about selection of anticoagulants, Alcohol consumption and selection of AED(anti epileptics). ABC of Heparin:-There are two complications which we have to vigilant during the course of UFH therapy . .  Such uses are A) Drug induced thrombocytopenia(probality is around 0.2%). & B) heparin induced osteoporosis. Heparin is usually commenced in early preg but if continued up to term then only these two compl have to keep in mind. Late onset thrombocytopenia is still rarer as that may occur as an  idiosyncratic reaction:: Idiosyncratic) “ Thrombocytopenic Thrombocytopenia”.