What are the AHA/ASA guidelines on stroke prevention during pregnancy?

Updated: Jan 10, 2016
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Both the 2014 AHA/ASA guidelines for secondary prevention of stroke and the 2012 ACCP evidence-based guidelines for antithrombotic therapy provide consistent recommendations for treatment of conditions that would require anticoagulation outside of pregnancy. [7, 13]

For high-risk conditions (class IIa):

  • LMWH twice daily throughout pregnancy, with dose adjusted to achieve the LMWH manufacturer’s recommended peak anti-Xa activity 4 hours after injection, or
  • Adjusted-dose unfractionated heparin (UFH) throughout pregnancy, administered subcutaneously every 12 hours in doses adjusted to keep the midinterval activated partial thromboplastin time (aPTT) at least twice control or to maintain an anti-Xa heparin level of 0.35 to 0.70 U/mL, or
  • UFH or LMWH (as above) until the 13th week, followed by substitution of a vitamin K antagonist (VKA) until close to delivery, when UFH or LMWH is resumed.
  • When delivery is planned, discontinue LMWH ≥24 hours before induction of labor or cesarean section (c lass IIa).

For low-risk conditions where antiplatelet therapy would be the treatment recommendation outside of pregnancy (class IIb):

  • UFH or LMWH, or no treatment, may be considered during the first trimester of pregnancy depending on the clinical situation (class IIb)
  • Low-dose aspirin (50–150 mg/d) after the first trimester of pregnancy (class IIa)

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