GTG 37a: reducing risk of VTE in pregnancy and puerperium Flashcards
Antenatal and postnatal VTE risk management of: Previous single unprovoked VTE
Start prophylactic dose LMWH in 1st trimester
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of: Recurrent VTE
LMWH from 1st trimester at an increased dose e.g. 50%, 75% or full treatment dose
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of: Antithrombin deficiency + previous VTE
LMWH from 1st trimester at an increased dose e.g. 50%, 75% or full treatment dose
will need haematology input +/- factor Xa replacement in delivery/labour
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of: Anti-phospholipid syndrome + previous VTE
LMWH from 1st trimester at an increased dose e.g. 50%, 75% or full treatment dose
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of: Single provoked VTE with no other risk factors
Start prophylactic dose LMWH at 28 weeks
Monitor carefully for other risk factors
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of:
No VTE + antithrombin deficiency or protein C deficiency, protein S deficiency or homozygous factor V leiden, homozygous prothrombin gene mutation, compound heterozygote
Refer to expert
Consider antenatal prophylaxis
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of:
No VTE+ antiphospholipid antibodies, heterozygous factor V leiden, heterozygous prothombin gene mutation
If 3 additional risk factors give prophylactic dose LMWH from 1st trimester
If 2 additional risk factors give prophylactic dose LMWH from 28/40
If 1 additional risk factor give postnatal 10 days of LMWH
Unless family history of VTE – then give 6 weeks postpartum
Antenatal and postnatal VTE risk management of:
4 antenatal risk factors e.g. BMI 35, IVF pregnancy, age 40, Para 4
Give prophylactic dose LMWH from first trimester
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of:
3 antenatal risk factors e.g. BMI 35, IVF pregnancy, age 41
Give prophylactic dose LMWH from 28 weeks
Give 6 weeks postpartum
Antenatal and postnatal VTE risk management of:
2 postpartum risk factors e.g. BMI 35, age 37
Does not require antenatal LMWH Give 10 days LMWH postpartum
Antenatal and postnatal VTE risk management of: Admission to hospital in pregnancy
Give LMWH unless contraindicated
Antenatal and postnatal VTE risk management of: Major surgery in pregnancy
Assess other risk factors but consider course of LMWH unless contraindicated
Antenatal and postnatal VTE risk management of: Ovarian hyperstimulation syndrome
Consider LMWH – give if severe or critical OHSS. Higher risk is late onset or pregnant – continue for duration of 1st trimester
Antenatal and postnatal VTE risk management of: Hyperemesis
Give LMWH unless contraindicated until hyperemesis has resolved
Antenatal and postnatal VTE risk management of:
BMI >40
As a risk factor alone – does not require LMWH antenatally
Counts as 2 risk factors postnatally therefore for if no additional risk factors – 10 days LMWH
Needs a spinal/epidural (on prophylactic dose LMWH)
Stop LMWH 12 hours before
Needs a spinal/epidural (on treatment dose LMWH)
Stop LMWH 24 hours before
Postpartum and had a spinal
Restart LMWH >4 hours after spinal
Postpartum and had an epidural
Remove catheter >12 hours after last dose of LMWH
Postpartum VTE risk management:
Emergency c-section
Counts as 2 postnatal risk factors – give 10 days if no additional risk factors
Postpartum VTE risk management:
Pre-clampsia, mid-cavity forceps, preterm delivery 36+2/40, PPH 1.5litres
4 risk factors – needs LMWH for 6 weeks postpartum
What proportion of fetuses develop warfarin embryopathy?
5%
What are the features of warfarin embryopathy?
Hypoplasia of nasal bridge Congenital heart defects Ventriculomegaly Stipled epiphyses Agenesis of the corpus callosum
What is danaparoid?
Heparinoid used under advisement by a haematologist for patients who have had HIT or skin reaction to heparin
Safe in breastfeeding
