Approach Considerations

Long-Term Monitoring

Therapeutic and prophylactic management for VTE postpartum is as mentioned previously.

Estrogen-containing contraception has been shown to increase the risk of VTE 35-99 times above baseline.^{[48, 49]}Therefore, estrogen-based contraception is contraindicated in a patient with a VTE associated with estrogen (eg, oral estrogen containing contraceptive) or thrombophilia. Nonetheless, screening all women prior to initiating estrogen-containing contraception is not recommended by ACOG.^{[49, 50]}Other contraceptive methods that do not include estrogen, including progestin-containing contraceptives, may be considered in women with a prior VTE or known thrombophilia.^{[49, 50]}

Medication

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Media Gallery

Estimated gestational age at time of diagnosis of antepartum deep venous thrombosis (n=94).
May-Thurner syndrome
Factors affecting thrombosis in Pregnancy
Diagnostic algorithm for suspected Deep-Vein Thrombosis and Pulmonary Embolism during pregnancy.
Suspected pulmonary embolism

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Table 1. Evidence-Based Clinical Practice Guidelines for Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy.

Table 1. Evidence-Based Clinical Practice Guidelines for Venous Thromboembolism, Thrombophilia, Antithrombotic Therapy, and Pregnancy.

Risk Factor	Recommendations
Women with a single episode of VTE associated with a transient risk factor that is no longer present	Clinical surveillance and anticoagulant prophylaxis postpartum*
Women with a single episode of VTE and thrombophilia (confirmed laboratory abnormality) and a strong family history of thrombosis who are not receiving long-term anticoagulants	Prophylactic or intermediate-dose LMWH or unfractionated heparin (UFH), plus postpartum anticoagulation for at least 6 wk (for a total minimum duration of therapy of 6 mo)
Women with antithrombin deficiency and no previous VTE	Antepartum and postpartum prophylaxis
Women with thrombophilia (other than antithrombin deficiency) and no previous VTE	Clinical surveillance or prophylactic LMWH or UFH and anticoagulant prophylaxis postpartum*
Women with multiple (≥ 2) episodes of VTE who are not receiving long-term anticoagulants	Prophylactic, intermediate-dose or adjusted-dose UFH or adjusted-dose LMWH followed by long-term anticoagulation postpartum
Women with multiple (≥ 2) episodes of VTE who are receiving long-term anticoagulants	Adjusted-dose UFH or LMWH followed by resumption of long-term anticoagulation postpartum
All women with previous DVT, antenatal and postpartum	Use of graduated elastic compression stockings
Women with recurrent pregnancy loss (≥ 3 miscarriages) and women with severe or recurrent preeclampsia, placental abruption, or otherwise unexplained intrauterine growth retardation	Screen for thrombophilia and antiphospholipid antibodies
Women with antiphospholipid antibody syndrome and a history of multiple (≥ 2) early pregnancy losses or ≥ 1 late pregnancy losses, preeclampsia, intrauterine growth retardation (IUGR), or abruption	Antepartum aspirin plus prophylactic or intermediate-dose UFH or LMWH
Women with APLAs and a history of VTE who are usually receiving long-term oral anticoagulation therapy	Adjusted-dose LMWH or UFH therapy plus low-dose aspirin and resumption of long-term oral anticoagulation therapy postpartum
* If the previous risk factor is pregnancy or estrogen-related or additional risk factors (such as obesity) are present, antenatal anticoagulant prophylaxis is recommended.

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Thromboembolism in Pregnancy Treatment & Management

Approach Considerations

Long-Term Monitoring

References

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