Thromboembolism in Pregnancy

Publication Date: July 1, 2018

Recommendations

When signs or symptoms suggest new onset DVT, the recommended initial diagnostic test is compression ultrasonography of the proximal veins. (A)
574

In general, the preferred anticoagulants in pregnancy are heparin compounds. (B)
574

Because of its greater reliability and ease of administration, low-molecular-weight heparin is recommended rather than unfractionated heparin for prevention and treatment of VTE within and outside of pregnancy. (B)
574

A reasonable approach to minimize postpartum bleeding complications is resumption of anticoagulation therapy no sooner than 4–6 hours after vaginal delivery or 6–12 hours after cesarean delivery. (B)
574

Because warfarin, low-molecular-weight heparin, and unfractionated heparin do not accumulate in breast milk and do not induce an anticoagulant effect in the infant, these anticoagulants are compatible with breastfeeding. (B)
574

Women with a history of thrombosis who have not had a complete evaluation of possible underlying etiologies should be tested for antiphospholipid antibodies and for inherited thrombophilias. (C)
574

Adjusted-dose (therapeutic) anticoagulation is recommended for women with acute thromboembolism during the current pregnancy or those at high risk of thrombosis, such as women with a history of recurrent thrombosis or mechanical heart valves. (C)
574

When reinstitution of anticoagulation therapy is planned postpartum, pneumatic compression devices should be left in place until the patient is ambulatory and until anticoagulation therapy is restarted. (C)
574

Every unit should have a protocol for when pregnant women and postpartum women should have anticoagulant medications held and when women who are receiving thromboprophylaxis are eligible for neuraxial anesthesia. (C)
574

Women receiving anticoagulation therapy may be converted from low-molecular-weight heparin to the shorter half-life unfractionated heparin in anticipation of delivery, depending upon the institution’s protocol. (C)
574

For women who are receiving prophylactic lowmolecular-weight heparin, discontinuation is recommended at least 12 hours before scheduled induction of labor or cesarean delivery; a 24-hour interval is recommended for patients on an adjusted-dose regimen. (C)
574

Placement of pneumatic compression devices before cesarean delivery is recommended for all women, and early mobilization is advised after cesarean delivery. (C)
574

Each facility should carefully consider the risk assessment protocols available and adopt and implement one of them in a systematic way to reduce the incidence of VTE in pregnancy and the postpartum period. (C)
574

Recommendation Grading

Disclaimer

Overview

Title

Thromboembolism in Pregnancy

Authoring Organization

Publication Month/Year

July 1, 2018

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D011247 - Pregnancy, D011250 - Pregnancy Complications, Hematologic, D013923 - Thromboembolism, D011248 - Pregnancy Complications

Keywords

thromboembolism, pregnancy, VTE in pregnancy