VTE In Pregnancy

Question 1

Is pregnancy a risk factor for developing VTE?

Answer 1

Yes, increases risk by 4-6x

Question 2

Pregnancy is a hypercoagulative state, which coagulation factors are elevated?

Answer 2

Fibrinogen, factor VIII,IX and X

Concentration of endogenous anticoagulants decrease

Question 3

Should all women be assessed for their individual risk during pregnancy?

Answer 3

Yes so that appropriate prophylactic measures can be initiated

Question 4

When should risk assessment be done?

Answer 4

At booking and on any subsequent hospital admission

Question 5

Is a woman with a previous VTE history automatically considered high risk?

Answer 5

Yes - require LMWH throughout antenatal period and input from experts

Question 6

What pre existing risk factors are there?

Answer 6

Age >35
BMI >30
Parity >3 
Smoking 
Gross varicose veins
Immobility 
FH of unprovoked VTE 
Previous VTE 
IVF therapy

Question 7

What obstetric factors are risks?

Answer 7

Multiple pregnancy
Pre-eclampsia
Prolonged labour
Instrumental delivery
CS
Still birth 
Preterm birth 
PPH >1L

Question 8

How many risk factors warrant immediate treatment with LMWH?

Answer 8

Four or more

Question 9

How long should LMWH be continued for ?

Answer 9

Until 6 weeks postnatal

Question 10

If a woman has 3 risk factors what should be done?

Answer 10

LMWH start from 28weeks and continue until 6 weeks postnatal

Question 11

Should DOACs and warfarin be avoided in pregnancy?

Answer 11

Yes

Question 12

What blood test can be done to monitor LMWH treatment?

Answer 12

Anti-Xa activity

Question 13

Is a DVT on left or right more common in pregnancy?

Answer 13

Left sided 85%