Bayer Pharma AG

Essence of this Article

According to current guidelines, women with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) or known thrombophilia should start anticoagulant therapy as early as possible during pregnancy. Thromboprophylaxis after childbirth is not normally indicated, but may be necessary in certain cases. Appropriate risk stratification is essential to determine if thromboprophylaxis is necessary and may be used to guide the intensity of thromboprophylaxis to maintain the optimal balance between efficacy and safety. Low molecular weight heparin (LMWH) is the heparin of choice for prophylaxis in pregnant patients. Mechanical prophylactic strategies for pregnant women include: physiotherapy and exercise; use of graduated compression stockings; foot pumps; and intermittent pneumatic compression devices.

Prevention of venous thromboembolism in pregnancy

According to current guidelines, women with a history of DVT or PE or known thrombophilia should start anticoagulant therapy as early as possible during pregnancy, owing to the potential occurrence of venous thromboembolism (VTE) in all trimesters.267

Thromboprophylaxis is recommended in pregnant women who have or have had:

  • Previous VTE
  • Thrombophilia, including certain concomitant genetic mutations, such as polymorphisms in the genes for Factor V (Factor V Leiden) and prothrombin (G20210A)
  • Antithrombin deficiency
  • Antiphospholipid syndrome267, 268

Thromboprophylaxis after childbirth is not normally indicated, but may be in the case of:

  • Prolonged labour
  • Mid-forceps delivery
  • Immobility after delivery269

Appropriate risk stratification (including an assessment of patient history) is essential to determine if thromboprophylaxis is necessary and may be used to guide the intensity of thromboprophylaxis to maintain the optimal balance between efficacy and safety.

  • In a cohort of 810 pregnant women who had the intensity of their thromboprophylactic regimens determined according to risk stratification, a low incidence of symptomatic venous thromboembolic events were seen, with low rates of clinically relevant bleeding and other adverse events270

LMWH is the heparin of choice for prophylaxis in pregnant patients owing to its acceptable safety profile for both mother and foetus, as well as a convenient once-daily dosing regimen for most patients, compared with unfractionated heparin.271, 272
Mechanical prophylactic strategies for pregnant women include:

  • Physiotherapy and exercise
  • Use of graduated compression stockings
  • Foot pumps
  • Intermittent pneumatic compression devices258

Recommendations for the treatment of VTE in pregnancy are covered by guidelines.


Where to next?