NPMS recommendations: Antepartum vs postpartum prophylaxis

National Partnership for Maternal Safety recommendations for antepartum outpatient prophylaxis

Women with prior VTE-especially if the episode was associated with pregnancy or use of estrogen-containing oral contraceptives-are at increased risk for recurrent VTE during pregnancy or postpartum. VTE risk also is increased in women with high-risk thrombophilias. Women with prior VTE and low-risk thrombophilias also are at increased risk. These data led to clear recommendations from the American College of Obstetricians and Gynecologists (ACOG) for antepartum and postpartum prophylaxis for women with prior VTE and/or thrombophilias.^1,2

Related: A simple step to reduce maternal death: Improve VTE prevention

National Partnership for Maternal Safety recommendations for postpartum prophylaxis after hospitalization for childbirth

Thromboprophylaxis is almost always initiated after vaginal delivery or cesarean, typically at least 6 hours later. This allows for safe administration of neuraxial analgesia or anesthesia and removal of a catheter. However, VTE may already have formed by that time, in which case, prophylaxis may be useless or less effective compared to when it is used prior to and during surgery. Another knowledge gap is the optimal duration of thromboprophylaxis. Heparin or low-molecular-weight heparin (LMWH) may be continued until the patient is ambulatory, until she is discharged from the hospital, through 10 days after delivery or 6 weeks after delivery.³ The relative merits of each time interval are uncertain. The same is true for various doses and drugs used for thromboprophylaxis. Although knowledge gaps exist, ACOG has a practice bulletin summarizing available regimens.²

Disclosures:

The authors report no potential conflicts of interest.

References:

• Inherited thrombophilias in pregnancy. ACOG Practice Bulletin Number 197. Obstet Gynecol. 2018;132:e18-34.

• Thromboembolism in pregnancy. ACOG Practice Bulletin Number 196. Obstet Gynecol. 2018;132:e1-17.

• The Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium. Guideline No. 37a. London: RCOG; 2015.