VTE in pregnancy Flashcards

1
Q

Overall incidence of PE in pregnancy and puerperium

A

1-2 per 1000
1.3 per 10,000 antenatally

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2
Q

Increase in risk of VTE in pregnnacy and postpartum

A

4-6 fold increase
21-84 fold increase compared to non-preg, 5 fold pregnant rate

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3
Q

Treatment dose tinzaparin

A

175units/kg

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4
Q

Treatment dose dalteparin

A

<50kg: 5000units BD
50-69kg: 6000units BD
70-89kg: 8000units BD
90-109kg: 10,000units BD
110-125kg: 12,000 units BD
>125kg = d/w haem
OD dosing double BD dose

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5
Q

Increased risk of VTE if BMI >30

A

PE: OR = 14.9
DVT: OR = 4.4

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6
Q

Increased risk of VTE whilst in hospital

A

18 fold increase

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7
Q

Increased risk of VTE when discharged from hospital

A

6 fold higher for 28 days

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8
Q

Risk of VTE in IVF pregnancy
Overall
1st trimester

A

Overall: 2x higher
T1: VTE 4x higher, PE 7x higher

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9
Q

Recurrence rate of VTE in pregnancy

A

11% during pregnancy
3% post pregnancy

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10
Q

Thromboprophylaxis if single previous VTE

A

At least post-partum LMWH

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11
Q

Anti-thrombin deficiency and previous VTE tx

A

High risk of recurrence
Give higher dose LMWH (up to tx dose) and continue until 6/52 PP or PO anticoag restarted

Consider anti-Xa monitoring (target 0.5 – 1.0 iu/ml at 4 hours post-dose) and anti-thrombin replacement at initiation of labour or prior to CS

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12
Q

APS and previous VTE - risk and management

A

High risk of recurrence
Give higher dose LMWH (up to tx dose) and continue until 6/52 PP or PO anticoag restarted

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13
Q

High risk thrombophilias
What are they?
Management

A

Antithrombin deficiency
Protein C or S deficiency
Compound or homozygous for low-risk thrombophilia

Consider antenatal LMWH
Recommend post-partum LMWH for 6 weeks
Use standard prophylactic dose except anti-thrombin deficiency where intermediate dose may be required

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14
Q

Lower risk thrombophilias
What are they?
Management?

A

Heterozygous for factor V Leiden or prothrombin G20210A mutations
Antiphospholipid antibodies

Counts as 1x minor VTE risk factorM

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15
Q

Major VTE risk factors postnatal

A

Any previous VTE
Anyone requiring antenatal LMWH
High-risk thrombophilia (antithrombin deficiency, protein C or S deficiency, compound or homozygous for low-risk thrombophilia)
Low-risk thrombophilia (heterozygous for factor V Leiden or prothrombin G20210A mutations, antiphospholipid antibodies) + FHx of VTE

Tx = 6 weeks LMWH

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16
Q

Intermediate risk factors postnatal

A

Caesarean section in labour
BMI >/= 40 kg/m2
Re-admission or prolonged admission (>/= 3 days)
Any surgical procedure except immediate perineal repair
Medical comorbidities

Tx = 10 days postnatal

17
Q

Risk of VTE post CS

A

ELCS: 2x SVB
EMCS: 4x SVB