What is included in the medical care for hypercoagulability during pregnancy?

Updated: Jan 05, 2018
  • Author: Paul Schick, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Primary prophylaxis in patients with thrombophilia during pregnancy is controversial. Patients with thrombophilia, a history of thrombosis, and other risk factors could be considered for prophylactic anticoagulation, especially during the first 6 weeks postpartum, when the risk of thrombosis is greatest. Anticoagulation should be strongly considered during pregnancy and in the postpartum period in patients with lupus anticoagulants. [25]

Conners provided guidance for the use of antepartum and postpartum prophylaxis with low molecular weight heparin (LMWH)  in women with a known thrombophilia or prior venous thrombosis. Management of LMWH prophylaxis use around labor and delivery was also reviewed. [26]

A multicenter study of 2554 patients revealed that after a first unprovoked venous thromboembolism (VTE), men have a 2.2-fold higher risk of recurrent VTE than do women; this risk remained 1.8-fold higher in men after adjustment for previous hormone-associated VTE in women. [27] In patients with a first provoked VTE, risk of recurrence does not differ between men and women, with or without adjustment for hormone-associated VTE. This information might be useful when deciding on whether long-term anticoagulation is indicated


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