Thromboembolism in pregnancy (VTE & PE)

Question 1

RFs for VTE in pregnancy? How many needed for immediate treatment (with what)?

Answer 1

1. Age > 35
2. Body mass index > 30
3. Parity > 3
4. Smoker
5. Gross varicose veins
6. Current pre-eclampsia
7. Immobility
8. Family history of unprovoked VTE
9. Low risk thrombophilia
10. Multiple pregnancy
11. IVF pregnancy

4 or more RFs needed for treatment with LMWH (enoxaparin, factor 10a inhibitor)

-. Direct Oral Anticoagulants (DOACs) and warfarin should be avoided in pregnancy.

Question 2

how long should LMWH be continued postpartum?

Answer 2

Four or more risk factors warrants immediate treatment with low molecular weight heparin continued until six weeks postnatal.

If a woman has three risk factors low molecular weight heparin should be initiated from 28 weeks and continued until six weeks postnatal.

Question 3

If VTE diagnosis made in pregnancy, how long should LMWH be continued for?

Answer 3

If diagnosis of DVT is made shortly before delivery, continue anticoagulation treatment for at least 3 month, as in other patients with provoked DVTs.

Question 4

what are the risks of CTPA vs VQ scan in pregnancy?

Answer 4

CTPA: increased risk of breast cancer for mother
VQ scan: increased risk of childhood cancer
- D dimer test shouldn’t be done in pregnancy

Question 5

Investigations for PE in pregnancy:

Answer 5

In A & E: ECG (right heart strain, tachycardia, S1Q3T3 pattern), & CXR
-If +ve signs of DVT–> compression Duplex USS (if +ve–> start treatment)
-If -ve signs of DVT–> CTPA or VQ scan

Of these, a V/Q scan exposes the patient to by far the lowest radiation dose, and is thus the preferred investigation in pregnant women.

Question 6

Answer 6

Thromboembolic deterrent stockings and LMWH (eg enoxaparin)