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For acute thrombosis or thrombosis prophylaxis in pregnancy, use low-molecular-weight heparin (LMWH) as first-line therapy unless contraindicated.
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Follow pregnant patients on therapeutic LMWH with anti–factor Xa levels (target level of 0.6–1 unit/mL 4 hours after dose) every 1 to 3 months. Patients on prophylactic LMWH do not require monitoring unless they have a body mass index greater than 40 or have renal disease.
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Patients with lupus anticoagulant on unfractionated heparin (UFH), or any
Guidelines for Use of Anticoagulation in Pregnancy
Section snippets
Key points
Conclusion
The recommendations above are based on the current guidelines for anticoagulation in pregnancy for patients with an acute thromboembolism or thromboembolism prevention. These recommendations may also be applicable for patients that require anticoagulant therapy in pregnancy for other reasons, see articles by Lockshin, Odibo and Stout, and Paidas and Hossain elsewhere in this issue.
References (58)
- et al.
Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy
Obstet Gynecol
(1999) - et al.
Pulmonary thromboembolism following gynecologic surgery and cesarean section
Int J Gynaecol Obstet
(2004) - et al.
Risk of pregnancy associated recurrent venous thromboembolism in women with a history of venous thrombosis
J Thromb Haemost
(2005) - et al.
Thromboembolism in pregnancy
Obstet Gynecol Clin North Am
(2007) - et al.
Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
(2012) - et al.
A diagnostic test for heparin-induced thrombocytopenia
Blood
(1986) - et al.
Gender imbalance and risk factor interactions in heparin induced thrombocytopenia
Blood
(2006) - et al.
Heparin-induced thrombocytopenia in hospitalized patients with venous thromboembolism
Am J Med
(2009) - et al.
Heparin-induced thrombocytopenia: temporal pattern of thrombocytopenia in relation to initial use or re-exposure to heparin
Chest
(2002) - et al.
Low molecular weight heparin does not cross the placenta during the second trimester of pregnancy study by direct fetal blood sampling under ultrasound
Thromb Res
(1984)
Pharmacokinetics of heparin and low molecular weight heparin
Baillieres Clin Haematol
Effect of fondaparinux on platelet activation in the presence of heparin-dependent antibodies: a blinded comparative multicenter study with unfractionated heparin
Blood
Anticoagulation with argatroban in a parturient with heparin-induced thrombocytopenia
Int J Obstet Anesth
Bleeding risk and reversal strategies for old and new anticoagulants and antiplatelet agents
J Thromb Haemost
Anticoagulants and their reversal
Transfus Med Rev
Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomized controlled trial
Lancet
Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
Is warfarin sodium contraindicated in the lactating mother?
J Pediatr
Development and in vivo bioavailability study of an oral fondaparinux delivery system
Eur J Pharm Sci
Hirudin treatment in a breastfeeding women
Lancet
Maternal-fetal medicine principles and practice
Practice Bulletin No. 123. American College of Obstetrics and Gynecologist
Obstet Gynecol
Safety of withholding heparin in pregnant women with a history of venous thromboembolism
N Engl J Med
Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature
J Coagul Disord
Vitamin K antagonists and pregnancy outcome. A multi-center prospective study
Thromb Haemost
VET, thrombophilia, antithrombic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
Subcutaneous heparin therapy during pregnancy: a need for concern at the time of delivery
Thromb Haemost
Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer
N Engl J Med
Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
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2016, International Journal of Obstetric AnesthesiaCitation Excerpt :Data regarding novel anticoagulant drugs such as direct thrombin inhibitors or factor Xa inhibitors are not available but some of these drugs are known to cross the placenta. Treatment during pregnancy has only been reported in patients who have developed heparin-induced thrombocytopenia.20 It is uncertain if treatment with thrombolysis would have been successful but in this case the risk of bleeding was judged to be too high.
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None of the authors have any relationship to disclose.