Venous Thromboembolism (VTE) During Pregnancy

Choice of drug:

• 1st line: LMWHLow molecular weight heparin (e.g. enoxaparin)
• 2nd line: UFHUnfractionated heparin

Dosing and monitoring:

• Dose is weight-based (typically based on actual body weight), the exact dose also depends on risk stratification
• Routine monitoring of anti-Xa level is NOT required
• Routine monitoring of platelet count is NOT required (unless there is a prior exposure to UFHUnfractionated heparin)

Safety:

• LMWHLow molecular weight heparin is safe in breastfeeding
• It is worth noting that warfarin is safe in breastfeeding, but NOT in pregnancy (it is highly teratogenic). DOACsDirect oral anticoagulants are contraindicated in BOTH pregnancy and breastfeeding.

In clinically suspected DVT or PE, treatment with LMWHLow molecular weight heparin should be commenced immediately (without awaiting for diagnostic confirmation), unless treatment is strongly contraindicated.

It should then only be stopped, if the diagnosis is excluded by objective testing.

D-dimer testing should NOT be performed in the investigation of  VTE in pregnancy.

IV UFHUnfractionated heparin is the preferred, initial treatment in massive PE with cardiovascular instability.

Warfarin and DOACsDirect oral anticoagulants are contraindicated during pregnancy.