VTE Prophylaxis

Question 1

Which 2 VTE prophylaxis are safe in preg? (don’t cross the placenta)

Answer 1

Heparin and LMWH

Question 2

What is the only exception for warfarin use in pregnancy/ breast feeding?

Answer 2

High risk of valve thrombosis, can be used from 12-36 weeks

Question 3

Why can’t NOACs be given in pregnancy?

Answer 3

Can cause placental haemorrhage

Question 4

Mx of women with >4 risk factors (other than previous VTE or thrombophilia)

Answer 4

Prophylactic LMWH throughout antenatal period + 6 weeks postnatal

Question 5

Mx of women with 3 risk factors (other than previous VTE or thrombophilia

Answer 5

Prophylactic LMWH from 28 weeks + 6 weeks postnatal

Question 6

Mx of women with 2 risk factors (other than previous VTE or thrombophilia

Answer 6

Prophylactic LMWH for 10 days pp

Question 7

VTE prophylaxis for pregnant women admitted to hospital

Answer 7

Prophylactic LMWH

Question 8

Previous VTE

Answer 8

Prophylactic LMWH

Question 9

Mx of women with previous thrombophilia-associated VTE

Answer 9

Higher dose of LMWH (by 50 or 75%)

Question 10

Women on long-term warfarin: management in pregnancy

Answer 10

Stop warfarin + change to LMWH within 2 weeks of missed period + before the 6th week of pregnancy

Question 11

What are first trimester RFs for VTE?

Answer 11

Women admitted for hyperemesis (put on LMWH and stop when discharged)
OHSS or IVF pregnancy: LMWH from the first trimester

Question 12

Mx of women who have been on prophylactic LMWH who are now in labour

Answer 12

After any vaginal bleeding or once labour begins, should not inject any further LMWH

Question 13

When should the first thromboprophylactic dose of LMWH be given after delivery?

Answer 13

As soon as possible after delivery, i there is no pph + regional anaesthesia not used

Question 14

When is unfractionated heparin preferred over LMWH?

Answer 14

If there is an increased risk of haemorrhage or regional anaesthesia is used