A ow chart on how to manage women with AF during pregnancy is shown in Figure 8. Recommendations 45. For women receiving OAC for prevention of stroke/TE in AF who become pregnant, we suggest discontinuation of OAC with a VKA between weeks 6 and 12 and replacement by LMWH twice daily (with dose adjustment according to weight and target anti- Xa level 4-6 h post-dose 0.8-1.2 U/mL), especially in patients with a warfarin dose required of > 5 mg/day (or phenprocoumon > 3 mg/day or acenocoumarol > 2 mg/day). OAC should then be discontinued and replaced by adjusted-dose LMWH (target anti-Xa level 4-6 h post-dose 0.8-1.2 U/mL) in the 36th week of gestation (Ungraded consensus-based statement). 46. For women on treatment with long-term vitamin K antagonists who are attempting pregnancy and are candidates for LMWH substitution, we suggest performing frequent pregnancy tests and use LMWH instead of VKA when pregnancy is achieved rather than switching to LMWH while attempting pregnancy (Ungraded consensus-based statement). 47. For pregnant women, we suggest avoiding the use of NOACs (Ungraded consensus-based statement). Remark: For women on treatment with an NOAC we suggest switching to vitamin K antagonists, rather than switching to LMWH while attempting pregnancy. 48. For lactating women using warfarin, acenocoumarol, or UFH who wish to breast-feed, we suggest continuing the use of warfarin, Woman with AF on NOAC Woman with AF on VKA If planned pregnancy or diagnosis of pregnancy VKA until end of 5th week (LMWH as an alternative) VKA replaced by LMWH from 6th to 12th week LMWH replaced by VKA until 36th week (maintenance of LMWH as an alternative) VKA replaced by LMWH from 36th week to 24 h before delivery or cesarean section VKA or LMWH during lactation Figure 8 Management of women with AF during pregnancy is shown. 