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Venous thromboembolism in pregnancy

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of venous thromboembolism in pregnancy are prepared by our editorial team based on guidelines from the American Society of Hematology (ASH 2018). ...
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Diagnostic investigations

Evaluation for DVT: as per ASH 2018 guidelines, consider additional investigations (including serial compression ultrasound or MRV) after an initial negative ultrasound with for pregnant women with suspected DVT.
C
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  • Evaluation for PE

Medical management

General principles: as per ASH 2018 guidelines, initiate antithrombotic therapy in pregnant women with acute VTE.
A

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  • Setting of care

  • Choice of anticoagulant therapy

  • Thrombolytic therapy

  • Timing of delivery

Therapeutic procedures

Catheter-directed thrombolysis: as per ASH 2018 guidelines, consider avoiding catheter-directed thrombolysis therapy in pregnant women with acute lower-extremity DVT.
D

Specific circumstances

Patients undergoing assisted reproduction
As per ASH 2018 guidelines:
Consider avoiding prophylactic antithrombotic therapy to prevent VTE in unselected women undergoing assisted reproductive therapy.
D
Consider prophylactic antithrombotic therapy to prevent VTE in women undergoing assisted reproductive therapy, who develop severe ovarian hyperstimulation syndrome.
C

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  • Patients with superficial venous thrombosis

  • Patients who are breastfeeding

Preventative measures

Antepartum prophylaxis, primary prevention: as per ASH 2018 guidelines, consider administering primary prophylaxis for VTE during the antepartum period in women with antithrombin deficiency who have a family history of VTE, and in women who are homozygous for the FVL mutation or who have combined thrombophilias.
C
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  • Antepartum prophylaxis (secondary prevention)

  • Postpartum prophylaxis (primary prevention)

  • Postpartum prophylaxis (secondary prevention)

  • Dosing of prophylactic LMWH