Antithrombin Deficiency Guidelines

Updated: Aug 22, 2019
  • Author: Bryan A Mitton, MD, PhD; Chief Editor: Perumal Thiagarajan, MD  more...
  • Print
Guidelines

Guidelines Summary

Guidelines for the prevention of VTE during pregnancy and postpartum have been issued by the following organizations:

  • American College of Chest Physicians (ACCP)
  • American College of Obstetricians and Gynecologists (ACOG)
  • Royal College of Obstetricians and Gynaecologists (RCOG) 

 ACOG recommends testing for inherited thrombophilia in all pregnant women with a history of thrombosis. [61]  The lack of a strong and consistent evidence base has lead to differing recommendations for women with AT diviciency. For prevention of first VTE, the recommendations are as follows:

  • ACOG - Antepartum prophylaxis with low molecular weight heparin (LMWH) or unfractionated heparin (UFH) followed by 6 weeks postpartum anticoagulation [61]  
  • ACCP -  Antepartum clinical surveillance. Continue clinical surveillance postpartum if there is no family history of VTE; if there is a family history of VTE, 6 weeks prophylactic or intermediate dose LMWH or vitamin K antagonists targeted at INR 2.0–3.0. [62]
  • RCOG - Consider prophylactic dose LMWH in the presence of more than one thrombophilic defect or other risk factors [63]

Recommendations for prevention of recurrent VTE are as follows:

  • ACOG - Antepartum and 6 weeks postpartum prophalactic or intermediate dose of LMWH or UFH [61]  
  • ACCP -  Antepartum and 6 weeks postpartum prophalactic or intermediate dose LMWH. [62]
  • RCOG - Consultation with a hemotalogist and antepartum anti-factor Xa monitoring and higher dose (50-100%) LMWH followed by postpartum higher dose LMWH for 6 weeks or until long-term anticoagulation is started. [63]