GTG VTE in pregnancy

Question 1

What are the AN minor risk factors for VTE?

Answer 1

BMI >30
Age >35
Parity ≥3
Smoker
Varicose veins
PET (current)
Immobility
FHx unprovoked VTE
Low risk thrombophilia
Mutiple pregnancy
IVF/ART

Remember 2 of these = NO antenatal prophylaxis but YES to 10/7 PN

Question 2

How many AN minor risk factors do you need and what does this win you?

Answer 2

3 = prophylaxis from 28 weeks
4+ = prophylaxis from 1st T (and usually for 6w after)

Question 3

What are the AN intermediate risk factors for VTE?

Answer 3

Hospital admission
Single previous VTE after major surgery
High risk thrombophilia
Medical co-morbidity - cancer, HF, IBD, kidney disease, T1DM, SCD, current IVDU
Any current surgery
OHSS (1st T)

Question 4

What are the AN high risk factors for VTE

Answer 4

Any previous VTE (not related to surgery)

Question 5

If intermediate risk AN…

Answer 5

…consider AN prophylaxis with LMWH

Question 6

If high risk AN…

Answer 6

…requires AN prophylaxis with LMWH

Question 7

When do you get 6 weeks post-natal prophylactic LMWH?

Answer 7

Any previous VTE
Anyone requiring AN LMWH
High risk thrombophilia
Low risk thrombophilia AND FHx

Question 8

What are the indications for 10 days PN prophylactic LMWH?

Answer 8

CS in labour / other surgery in puerp
BMI >40
Prolonged admission >10 days / re-admission
Medical co-morbidities
2 or more minor risk factors

Question 9

What are the minor risk factors for PN VTE prophylaxis?

Answer 9

As antenatally
PLUS:
ELCS
PTB <37w
SB
Operative delivery
Prolonged labour >24h
PPH >1L OR blood transfusion

Question 10

Very high risk thrombophilias?

Answer 10

antithrombin deficiency
antiphospholipid syndrome
require specialist haem input and usually have HIGH dose prophylaxis AN and PN

Question 11

Intermediate risk thrombophilias?

Answer 11

Homozygous factor V Leiden
Protein C or S deficiency

Answer 12

Prothrombin
Factor V Leiden heterozygote