VTE_in_Pregnancy_Flashcards
Why is pregnancy a risk factor for developing venous thromboembolism (VTE)?
Pregnancy is a risk factor for developing VTE due to physiological changes that increase the risk of blood clotting.
When should a risk assessment for VTE be completed during pregnancy?
A risk assessment for VTE should be completed at booking and on any subsequent hospital admission during pregnancy.
What is the protocol for a woman with a previous history of VTE during pregnancy?
A woman with a previous history of VTE is automatically considered high risk and requires low molecular weight heparin throughout the antenatal period, as well as input from experts.
What conditions place a woman at intermediate risk for developing VTE during pregnancy?
A woman at intermediate risk for developing VTE due to hospitalisation, surgery, co-morbidities, or thrombophilia should be considered for antenatal prophylactic low molecular weight heparin.
What risk factors increase a woman’s likelihood of developing VTE during pregnancy?
Risk factors that increase a woman’s likelihood of developing VTE during pregnancy include age > 35, body mass index > 30, parity > 3, smoker, gross varicose veins, current pre-eclampsia, immobility, family history of unprovoked VTE, low risk thrombophilia, multiple pregnancy, and IVF pregnancy.
What is the recommended treatment for a woman with four or more VTE risk factors during pregnancy?
If a woman has four or more VTE risk factors, she warrants immediate treatment with low molecular weight heparin continued until six weeks postnatal.
What is the recommended treatment for a woman with three VTE risk factors during pregnancy?
If a woman has three VTE risk factors, low molecular weight heparin should be initiated from 28 weeks and continued until six weeks postnatal.
What is the protocol for continuing anticoagulation treatment if DVT is diagnosed shortly before delivery?
If DVT is diagnosed shortly before delivery, anticoagulation treatment should be continued for at least 3 months, as in other patients with provoked DVTs.
What is the treatment of choice for VTE prophylaxis in pregnancy?
Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy.
Which anticoagulants should be avoided in pregnancy for VTE prophylaxis?
Direct Oral Anticoagulants (DOACs) and warfarin should be avoided in pregnancy for VTE prophylaxis.
Summarise VTE in pregnancy
Venous thromboembolism in pregnancy
Pregnancy is a risk factor for developing venous thromboembolism (VTE). By assessing a womans individual risk during pregnancy then appropriate prophylactic measures can be initiated. A risk assessment should be completed at booking and on any subsequent hospital admission.
A woman with a previous VTE history is automatically considered high risk and requires low molecular weight heparin throughout the antenatal period and also input from experts.
A woman at intermediate risk of developing VTE due to hospitalisation, surgery, co-morbidities or thrombophilia should be considered for antenatal prophylactic low molecular weight heparin.
The assessment at booking should include risk factors that increase the womans likelihood of developing VTE. These risk factors include:
Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF pregnancy
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.
If diagnosis of DVT is made shortly before delivery, continue anticoagulation treatment for at least 3 month, as in other patients with provoked DVTs.
Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy. Direct Oral Anticoagulants (DOACs) and warfarin should be avoided in pregnancy.
A 32-year-old lady presents to the booking clinic. She is approximately 8 weeks pregnant. During the consultation, it comes to light that she has had two deep vein thromboses in the past. Which of the following will she require given her history of previous VTEs?
Warfarin, starting immediately until 6 weeks postnatal
She does not require primary VTE prophylaxis
Low molecular weight heparin, starting immediately until 6 weeks postnatal
Unfractionated heparin, starting immediately until 6 weeks postnatal
VTE prophylaxis starting from 35 weeks of pregnancy until 6 weeks postnatal
Low molecular weight heparin, starting immediately until 6 weeks postnatal
Pregnant woman with a previous VTE history: LMWH throughout pregnancy until 6 weeks postnatal
Important for meLess important
Women with a VTE history should be anticoagulated during pregnancy until 6 weeks postnatal due to the increased risk of clotting during pregnancy. Warfarin is teratogenic during pregnancy and the standard medication used for this is low molecular weight heparin as this requires less monitoring and has a reduced side effect profile.
