Reference: ASH 2018 guidelines
1. Start prophylaxis if : she has a hx of VTE that was unprovoked or associated with a hormonal risk factor, the ASH guideline panel recommends antepartum anticoagulant prophylaxis over no anticoagulant prophylaxis. continue that for 6 weeks post partum.
2. Do not start prophylaxis if the prior VTE was associated with a nonhormonal temporary provoking risk factor and no other risk factors.
3. Antepartum+ post partum prophylaxis in thrombophilias:
-antithrombin deficiency + family history of VTE
-homozygous for the factor V Leiden mutation
-combined thrombophilias, regardless of family history of VTE
Questions to ask:
- every had a VTE? Provoked? Unprovoked? Related to hormones?
- family hx of VTE: pregnancy associated
- known thrombophilias
-any other risk factors: inflammatory diseases, smoking, obesity, pregnancy losses
Choice: standard dose LMWH in antepartum; standard or intermediate risk in post partum
Reference: Antiphospholipid Ab in pregnant women
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