x\_s=x8iu'I}pRN&_ v7/yY4g/d#e+Ll'o3[e]L4{)W>FhK?_.v3[IOg.tc:9L} Zp#%E^^GvMrTlf3y>>6qaf8t|E6J Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. 2.1 Preparation for Administration. Dont Let a Blood Clot Spoil Your Joy. Using heparin during pregnancy is not without risk. Anticoagulant therapy during pregnancy is indicated for the treatment and prophylaxis of venous thromboembolic disease and for the prevention and treatment of systemic embolism associated with valvular heart disease and/or . Tell your doctor if you have or have ever had heart disease, a stroke, deep venous thrombosis (DVT; blood clot in your leg), a pulmonary embolus (PE; blood clot in your lungs), or if you are going to have surgery. However, the use of other blood thinners such as Warfarin and Unfractionated Heparin (the type that was previously used) may pose a threat to the health of the mother as well as the baby. Table 1 lists a typical therapeutic LMWH dose.10,12,32,41 The optimal monitoring protocol with LMWH is controversial. Right now I have a HUGE cruise on my right side because I scratched my tummy on a chair so I've been injecting just on the left side for about 2 weeks and I've been fine. I also find icing before helps with the pain, and icing after helps the spot to be not quite as tender the next day. I inject on both sides. The most commonly used in pregnancy is 'low-molecular-weight heparin' (LMWH). @TwinkleStars15 that's really awesome to hear! PE occurs more commonly during the postpartum period than during pregnancy (relative risk = 15.0; 95% CI, 5.1 to 43.9),4 and 64 percent of postpartum VTEs occur after cesarean delivery. 2010;362(17):1586-96. doi:10.1056/NEJMoa1000641. She was on Lovenox for all three of her pregnancies. Your risk of developing a thrombosis will be assessed in pregnancy and after the birth of your baby. See permissionsforcopyrightquestions and/or permission requests. The experience of one miscarriage is devastating, let alone recurrent miscarriages. . Expecting or Recently had a Baby? Signs and symptoms of a DVT include Swelling of the affected limb Pain or tenderness not caused by injury I took heparin during my pregnancies (after having a DVT). Begin unfractionated heparin at 333 u/kg subcutaneous and then 250 u/kg subcutaneous q 12 hours. Of clinically suspected PE, only 4 percent are confirmed in pregnant patients, versus 30 percent in nonpregnant patients.17, Figure 1 presents an approach to the diagnosis and treatment of DVT in pregnancy derived from studies of non-pregnant patients.19,20 In nonpregnant women, a negative (low) d-dimer test combined with a low clinical probability score has a negative predictive value higher than 99.5 percent when a highly sensitive assay (e.g., enzyme-linked immunosorbent assay, latex turbidimetric assay) is used.19,20 However, d-dimer values increase progressively throughout pregnancy, and the ranges for normal values by gestational week are not yet universally established.21,22 Although a low d-dimer may be helpful in ruling out DVT, a positive (high) d-dimer result will be common during pregnancy and always requires confirmatory testing.12,20. I was already doing progesterone injections into my thighs. She likes to write research-based articles that are informative and relevant. Read our, Lupus Anticoagulant Antibodies and Repeated Miscarriage, Causes of Miscarriage in the Second Trimester, Differences Between Miscarriage Risk Factors and Miscarriage Causes, Most Common Factors That Contribute to First Trimester Miscarriage, How a Septate Uterus Increases Miscarriage Risk, Thrombophilia and pregnancy complications, Aspirin plus heparin or aspirin alone in women with recurrent miscarriage, Polycystic ovary syndrome (an endocrine disorder in which the ovaries are enlarged and contain cysts), At least one confirmed instance of thrombosis, The loss of a fetus beyond 10 weeks of gestation, Placental insufficiency or preeclampsia that results in preterm delivery at 34 weeks or less, Three or more early miscarriages (within the first 10 weeks of pregnancy). Previous campaign content is available for general information about blood clots as well as information for people who have been hospitalized or recently discharged home. [5] Use antibacterial soap. Bruising happens, you get used to it. How can I tell that my baby is getting enough milk? No adverse effects on any babies have been reported. The LMWH comes in preloaded syringes. Blood Clot Prevention Checklist for Pregnant Women, Blood Clot Risk Checklist for Pregnant Women, This Is Serious (Duke Haemostasis Center), Join the Public Health Webinar Series on Blood Disorders. You may be advised to start treatment with injections of heparin (an anticoagulant) to 'thin the blood'. collection of VTE educational resources published by The Joint Commission. does not cross the placenta but thins the blood just enough and very evenly to prevent blood clots. Choose an injection site on either your tummy or outer areas of your left or right thigh (see shaded areas). It crosses the placenta and increases the risk of miscarriage, stillbirth, embryopathy (nasal hypoplasia or stippled epiphyses), central nervous system abnormalities, and maternal and fetal hemorrhage.32 Warfarin is compatible with breastfeeding.32, Data derived from nonpregnant populations suggest that therapeutic anticoagulation following a first episode of VTE should continue for at least six months from diagnosis.38 Current recommendations for the duration of treatment in pregnancy range from three to six months, including six weeks postpartum.10,12,32 Long-term (i.e., longer than 12 months) anticoagulation is indicated for women with VTE and antiphospholipid antibody syndrome, or two or more thrombophilias,39 and for women with any thrombophilia and recurrent thrombotic events.40. The use of heparin during pregnancy has been prevalent for quite some time. Staying hydrated during pregnancy helps prevent clots by keeping the blood from getting too thick, Roshan said. Pregnant women may also experience less blood flow to the legs later in pregnancy because the blood vessels around the pelvis are pressed upon by the growing baby. Symptoms of dyspnea are nonspecific in pregnancy. BabyCenter may earn a commission from shopping links. There is no evidence that the heparin, including the one that we use (Enoxaparin), passes into breast milk due to the nature of the drug. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Therefore, precaution should be taken before using any blood thinners, especially if you are pregnant. This is called an embolus. The specific form of thrombophilia that's most often tied to miscarriage is calledantiphospholipid syndrome. Alcohol wipes to clean the skin before the injection. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Healthcare Professionals: Training and Education, Signs and Symptoms of Blood Clots with Cancer, Blood Clot Risk Checklist for Cancer Patients, Healthcare-Associated Venous Thromboembolism, U.S. Department of Health & Human Services. Do not pre-press on the piston protrusion to remove air bubbles, as this may disturb the dosage of the drug. Methods of receiving heparin subcutaneously include giving an injection at regular intervals, or using an indwelling catheter and an infusion pump. The role of thrombophilia in pregnancy. Myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) and polycythemia vera (PV) are rare during pregnancy. Warfarin, another anticoagulant taken in tablet form, does cross the placenta and may harm the unborn child (tetrogenic). While LMWH has the least cases of side effects during pregnancy, there have been cases where complications have been caused due to Unfractionated Heparin. Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. (AND I had some NASTY ones during that time--unfortunately, it is very normal)!! Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids as part of medication-assisted treatment for opioid use disorder. Talk with your healthcare provider about factors that might increase your risk for a blood clot. Overall though, it really does become second nature after a while. Some known causes of recurrent miscarriages include: Roughly 65% of women who have recurrent miscarriages with no known cause will have a successful pregnancy the next time they conceive.. It is not known whether heparin is excreted into breast milk. Another thingsince I didn't know it was necessary to change sites, I've been giving the injections primarily on my left side (because it doesn't hurt as much on that side, for whatever reason). There have been cases of blindness and deafness in the infants due to improper heparin dosage and administration. Heparin is an anticoagulant drug. U.S. National Library of Medicine, ToxNet. I.U,e3YtD:BjT CDC twenty four seven. Clinical suspicion is confirmed in 10 percent of pregnant women, compared with 25 percent of nonpregnant patients.17 Typical symptoms are unilateral leg pain and swelling. These cookies may also be used for advertising purposes by these third parties. These should be stored out of direct sunlight but do not need to be refrigerated. Women who take warfarin must switch to heparin or low molecular weight heparin before they become pregnant, since heparin or low molecular weight heparin (Lovenox, Fragmin) do not cross the placenta into the fetus. ]n^EkSfh-7wf9l^ifoio>ma_fq_n,B-/]KDw{hvS?n}"Ov$M t{o@M owG3| t>-K&A^}~Dzf&kA)R.D+-z vZ5__43Httiexies_yu}~6ui}+uzd[9u3Gq;w]l(PKdSn@"`j;Bg N 6kD`CLU(4ZZ`-H 'sAc6 fm/1Gdyzc%ott (I tried it). Heparin is considered the anticoagulant of choice during pregnancy, although anticoagulation and maternal disease state may pose a risk to both the mother and fetus. Recent findings: Low-molecular-weight heparins do not increase the risk of maternal bleeding during pregnancy. Women who are aware of their blood clotting problems are recommended to check with their doctors first and start the medication as prescribed. The incidence of refractory angina (22.9% in the placebo group) was significantly reduced to 8.5% ( P =0.002) in the heparin group and 10.7% in the heparin-plus-aspirin group ( P =0.11) but was 16.5% in the aspirin group. Pregnant women have an increased risk of venous thromboembolism (VTE) when compared with non-pregnant women because of changes in blood clotting. Sometimes it may be diluted and given to you as a slow injection into one of your veins (this is called an intravenous infusion). You can access these resources either from the campaign web portal or directly through the links provided below: This video shares important information about blood clot signs and symptoms, and risks for blood clots in women who are pregnant or have recently delivered a baby. Research supports this through various experiments conducted on animals and their results. 2023 Dotdash Media, Inc. All rights reserved. The optimal treatment of VTE during pregnancy has not been studied via randomized controlled trials, and clinical recommendations are based on expert opinion.10,12,24,32, Stabilization is the first priority. : CD009136. This is when the hormone is responsible for helping "prep" the uterus for the fertilized embryo. Heres why: Several other factors may also increase a pregnant womans risk for a blood clot: Too many women die from pregnancy-related complications and many more experience severe-pregnancy-related complications. Your tummy is usually best as the injection site. Thank you for taking the time to confirm your preferences. During pregnancy, heparin is prescribed to avoid potential blood clots, and also to deal with the critical complications arising due to blood clottings, such as preeclampsia, low birth weight, disruption of the placenta, and loss of the foetus. The #1 app for tracking pregnancy and baby growth. Introduction Injecting low molecular weight heparin (LMWH) while pregnant Thrombosis UK 4.19K subscribers Subscribe 128 Share 31K views 1 year ago An information film made with Miranda Hobson,. Do not rub the area. Using heparin during pregnancy is not without risk. l17'*}nN_Pq,~R/K-H 3W )Xg!~,k@fay}=A ,RBQh? Shelly- instead of emla or ametop which both take 45mins to an hour to work, you could use xzylocane Coldspray, which works instantly you just spray it on but its cold!!!! Visit CDCs new Hear Her campaign website to learn the warning signs to watch for during this exciting time. Should I have it checked? As of 2020, the campaign has realized more than 300 million media impressions. Was told to change injection sites because a small lump/bump can develop and will not go away. Lovenox is perfectly safe. endobj I've read on here that it's necesary to change injection sites, but my dr. didn't say anything about that. Already on long-term anticoagulation, e.g. This medicine, injected under the skin, is used to prevent or treat blood clots during and after pregnancy. Heparin has an average half-life of 60-90 minutes but is longer at higher doses. I started out numbing with ice but that just took too long lol. Opioid use during pregnancy can affect women and their babies. 1. Heparin is a form of anticoagulant used to prevent blood from clotting. Women are especially at risk for blood clots during pregnancy, childbirth, and the three-month period after delivery. :). I went through a bruising period of a few weeks, but honestly haven't had one in a long time. Good luck! Choose a site on the right or left side of your belly, at least 5 centimetres (2 inches) from your belly button. No. Take Steps to Protect Yourself and Your Baby from Blood Clots During Pregnancy and After Delivery Know the signs and symptoms of blood clots A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). For patients with diagnosed underlying health conditions, treatment can be tailored to improve the chance of a successful pregnancy. % Therefore it is considered that heparin is safe for you to have whilst you are breastfeeding. %PDF-1.5 You will be shown how to give yourself the injections before you go home but this leaflet also gives you instructions. Multidetector-row (spiral) computed tomography is the test of choice for pulmonary embolism. <>/PageLabels 375 0 R>> Lovenox (enoxaparin) is an anticoagulant (blood thinner) that works by blocking the activity of certain blood-clotting proteins. The Centers for Disease Control and Prevention (CDC) recommends a flu shot for all women who will be pregnant during the flu season, which is November through March. Airway, breathing, and circulation should be addressed immediately and may require management in the intensive care unit. Preparing Heparin Download Article 1 Wash your hands. I have to do enoxaparin injections once a day and started at 8 weeks (30 weeks now). A family or personal history of blood clots or a blood clotting disorder, Prolonged immobility (not moving a lot), such as during bed rest or recovery after delivery, Complications of pregnancy and childbirth, Certain long-term medical conditions, such as heart or lung conditions, or diabetes, Know the signs and symptoms of blood clots, A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). Either way, before taking any steps, we advise you to have a thorough discussion with your doctor and only then proceed further. Heparin is an anticoagulant commonly used after surgery. Heparin Sodium Injection, USP is a sterile solution of heparin sodium derived from porcine intestinal mucosa, standardized for use as an anticoagulant. Approximately 1% of women experience recurrent miscarriages, according to the American College of Obstetricians and Gynecologists. I really think that rotating sites helps too! In one study, women with recurrent pregnancy loss experienced a 71% subsequent live birth rate when treated with heparin and low-dose aspirin, compared to a 42% live birth rate for those given aspirin alone. Also Read:Blood Clot in the Uterus During Pregnancy: Causes, Complications & Treatment. 3. I really feel like they haven't been wonderful about communicating with me about any of this. LMWHs are recommended for the treatment of acute DVT and PE in pregnancy because of equivalent or superior effectiveness and safety compared with unfractionated heparin. Quasi-randomised studies and cross-over trials were not eligible for inclusion.. Methods of administering subcutaneous heparin include intermittent injections versus indwelling catheters or programmable (auto) external infusion pumps, or any other devices to facilitate the subcutaneous administration of heparin (UFH or LMWH) during pregnancy. With thrombophilia disorders, researchers believe that tiny clots get stuck in the developing placenta, blocking the flow of nutrients to the baby and eventually leading to an early pregnancy loss (or other complications, such as pre-eclampsia). Continuous IV infusion for a total of at least 30,000 IU over 24 hours, Monitor aPTT and adjust dose to maintain aPTT 1.5 to 2 times control value, DVT or PE with thrombogenic event (e.g., hip fracture, prolonged surgery), Antithrombin deficiency, homozygous factor V Leiden; two or more minor risk factors (i.e., heterozygous factor V Leiden and heterozygous prothrombin G20210A mutations), Single heterozygous factor V Leiden or heterozygous prothrombin G20210A mutation. Heparin has no known metabolites when broken down by the body. Haemodialysis Initially by intravenous injection Adult 2.2 This is important, as failure to wash your hands could introduce bacteria to the syringe - resulting in infection at the injection site. If eligible trials had been identified, trial quality would have been assessed and data extracted, unblinded by review authors independently. Heparin. Treatment is usually started when the pregnancy is confirmed. Studies reported only as abstracts were eligible for inclusion and would have been placed in studies awaiting assessment, pending the full publication of their results. `$hnvxZ}X=+zCTCT #=GES$CcCdL./&gSuE4WMVdU-GI$jaa7Qa[yN"o l>]h ta~]^H~}~mIc6a>L6;v{d>l"^KK Heparin should not be injected into a muscle. Heparin Use in Pregnancy. Stop Lovenox or Dalteparin for 12 hours and begin unfractionated heparin at 10,000 u q 12 hours. A couple minor inconveniences to your day! use of this site indicates your agreement to be bound by the Terms of Use. I wouldn't inject where the bruise is cause that would probably hurt pretty bad. Heparin is given by injection or drip into a vein (intravenously) or by injection under the skin (subcutaneously) to treat and prevent these types of blood clots. When all the heparin has been injected, slowly withdraw the needle at the same angle at which it entered, releasing the skin roll as you withdraw. endobj Welcome to lthe site! Multidetector-row (spiral) CT is the imaging modality of choice to evaluate for PE in pregnancy because, in nonpregnant patients, the diagnostic accuracy is equivalent to pulmonary angiography, and radiation exposure to the fetus is less than with a V/Q scan. But the good news is, blood clots may be preventable and treated if discovered early. Administer Heparin Sodium Injection by intermittent intravenous injection, intravenous infusion, or deep subcutaneous (intrafat, i.e., above the iliac crest or abdominal fat layer) injection. Simcox L, Ormesher L, Tower C, Greer I. Thrombophilia and pregnancy complications. If you could give me some advice/tips, I would REALLY appreciate it!! You can review and change the way we collect information below. The drug can be used prevent blood clots in lungs, veins, and arteries. Other diagnostic criteria for the syndrome include:. We're thinking of having a doula which sounds like such a silly posh person thing to do, we're not posh but I really feel like I could do with having an experienced advocate in there with me at the sharp end. I haven't done anything differently that I'm aware of. Pregnant? The information on this website is of a general nature and available for educational purposes only and There is no evidence from randomised controlled trials to evaluate the effectiveness and safety of different methods of administering subcutaneous heparin (UFH or LMWH) to pregnant women. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. During pregnancy, progesterone plays an important role, especially early in the first trimester. Good luck. And then administer the injection ask your Dr he could prescribe it. Some people prefer to inject the heparin fast, but I prefer to go slowly. For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. A sharps bin to dispose of the used needle and syringe. KING, MD, MPH. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. I have had to inject blood thinners several times, over the years. Therapeutic Stop Lovenox or Dalteparin for 12 hours. I also made sure to request the insulin needs and I dont feel a thing with the needle going in or any burn/sting with the meds. Does the heparin have to be injected into the stomach? If a very small amount passed into breast milk it is broken down by stomach acids therefore any absorption by a breast fed baby is negligible. However, the risk of developing a pulmonary embolus, once a DVT has been diagnosed and treated, is extremely small. :) I do heparin twice a day, on my morning injection I do the left side and in the evening I do the right side. From what I hear though, some really like it. Also, heparin is usually administered around the abdomen area where the fatty layers of the stomach do not permit the needle to get close to the foetus and harm it. I tried it a couple times, but I lack the patience. http://community.babycenter.com/post/a891375/tips_tricks_for_injections_-_list_em_here. interactive elements on the site, any assistance, or response you receive is provided by the author Therapeutic anticoagulation is indicated when DVT or PE is diagnosed. In extreme conditions, death has also been recorded. A clot arising during this or a previous pregnancy. Study with Quizlet and memorize flashcards containing terms like While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. I have read some folks do it on the inside of their thighs. It is also deemed safe for women to breastfeed when theyre on LMWH injections. Two weeks since my D&C and I still have a hard lump on my leg. As the risk of losing blood is high during and post-pregnancy stages, heparin is considered largely effective in stopping blood clots. LEE T. DRESANG, MD, PAT FONTAINE, MD, MS, LARRY LEEMAN, MD, MPH, AND VALERIE J. This was extremely painful and it made it difficult to walk. This medication is a commonly used anticoagulant in modern times. No trials met the inclusion criteria for the review. Use heparin sodium during pregnancy only if the potential benefit justifies the potential risk to the fetus. Another possible cause of recurrent miscarriage is a group of medical conditions that increase blood clotting, called thrombophilia disorders. Confirm the selection of the correct formulation and strength prior to administration of the drug. Every story is different, but below . Heparin is most often prescribed to prevent blood clots or miscarriages, and is usually given as a subcutaneous injection. LMWH is given as an injection. I hardly bruise at all. Diagnosing DVT is difficult during pregnancy. Let your provider know if you or anyone else in your family has ever had a blood clot. Heparin Sodium Market - Covid-19 Impact and Recovery Analysis: We have been tracking the direct impact of COVID-19 on this market, as well as the indirect impact from other industries. Hold the syringe in a dart fashion and insert the needle directly into the skin at a 45-90 degree angle just into the . Consider the benefits and risks of heparin sodium for the mother and possible risks to the fetus when prescribing heparin sodium injection to a pregnant woman. Although, the low molecular weight heparin is considered safe to use with regards to pregnancy, the Unfractionated Heparin version used before had several health risks associated with it. This is called an embolus. Saving Lives, Protecting People, also called venous thromboembolism or VTE. All these medications are safe for both the mother and the baby. Copyright 2008 by the American Academy of Family Physicians. Remove the cap from the needle. While multiple contributing factors may be involved, sadly about 50% to 75% of the time, there is no known cause for recurrent miscarriages. l= x FwdjEM!uULSQx44DVT Safe Sleeping & Caring for your Baby at Night, Southwest Neonatal Network Donor Milk Bank. When I first started the Heparin they just told me not to put it in the exact same spot but they never said I couldn't do it on one side. Some of the most common heparin side effects during pregnancy include: Heparin injection during pregnancy is usually administered to control blood clotting. We take your privacy seriously. Now that my belly is a lot bigger, I inject into my love handles or side of upper thigh (do that while sitting). Some women may not self-administer heparin and must rely on others to give them their injections otherwise they stop using the heparin, thus exposing themselves to an increased risk of VTE. If available, preservative-free heparin sodium injection is recommended when heparin therapy is needed during pregnancy. 2Li{.2e|s;G ;`%A. After deep subcutaneous (intrafat) injections, tests for adequacy of dosage are best performed on samples drawn 4 to 6 hours after the injection. I try to space out my sits by a couple inches to minimize tenderness. ,VxB7fbFv`y`/_ This content is owned by the AAFP. Some authorities recommend lower extremity venous compression ultrasonography as the next test because if DVT is present, anticoagulant treatment will be the same as for PE, and venous compression ultrasonography avoids fetal radiation exposure.12,28, When d-dimer testing and venous compression ultrasonography are inconclusive, multidetector-row (spiral) computed tomography has become the test of choice for diagnosing PE in pregnancy.12,24,26 Single-slice computed tomography is inadequate in diagnosing peripheral PE, but newer-generation spiral computed tomography, tested in nonpregnant patients, has shown positive and negative predictive values comparable with pulmonary angiography.27 Fetal exposure to radiation is lower with spiral computed tomography than with ventilation-perfusion (V/Q) scanning (less than 130 Gy and 370 Gy, respectively), and fetal exposure to spiral computed tomography nonionic contrast appears safe.29 Spiral computed tomography does expose the maternal breast to greater radiation, and V/Q scanning may be preferred in women with a family history of breast cancer.12 A cost-benefit analysis supports spiral computed tomography as the preferred test for diagnosing PE during pregnancy.30. You really want to make sure you aren't injecting in the same area. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Although its effect is not restricted to anticoagulation and also can modulate apposition , adhesion , and penetration of embryo . Verywell Family's content is for informational and educational purposes only. UFH is considered an acceptable alternative.32 Table 1 recommends dosages and monitoring.10,12,32,41 For postpartum DVT or PE, warfarin may be started concomitantly with heparin.42 LMWH or UFH should be continued until an international normalized ratio of 2.0 to 3.0 is achieved for two consecutive days.42 Post-thrombotic syndrome can be prevented if compression stockings are worn for at least one year starting in the first month after a DVT.1, Intrapartum management may vary depending on the indication for anticoagulation and whether therapeutic or prophylactic doses have been used.10 Expert guidelines suggest that women receiving adjusted-dose LMWH or UFH be instructed to discontinue heparin injections at the onset of labor to prevent anticoagulant complications during delivery.12,32 When delivery is predictable, as for elective induction or planned cesarean birth, LMWH or UFH should be discontinued 24 hours before delivery.12,32 For high-risk patients, such as those with mechanical heart valves or recent VTE, the American College of Obstetricians and Gynecologists (ACOG) recommends switching to intravenous heparin at the onset of labor.10 The short half-life of intravenous UFH allows discontinuation four to six hours before the anticipated time of delivery.10,32 To minimize spinal and epidural hematoma risk, the ACOG and the American Society of Regional Anesthesia advise avoiding regional anesthesia for 24 hours after the last LMWH dose for women on twice daily therapeutic doses of enoxaparin (Lovenox), and for 12 hours after the last dose of LMWH for women receiving daily prophylactic dosing.10, Evidence is insufficient to recommend for or against an inferior vena cava filter if anticoagulation is contraindicated or repeat PE occurs despite adequate anticoagulation.1, Systematic reviews of observational studies have found VTE prophylaxis with LMWH to be safe and effective in pregnancy, but there are no randomized controlled trials confirming this.35,42 Table 2 lists representative prophylactic doses of LMWH and subcutaneous UFH.6,43 Table 3 summarizes recommendations for the type and duration of prophylaxis based on specific clinical risk factors.5,10,15,32,39,40 Consultation should be considered for high-risk thrombophilias such as antithrombin deficiency.6, Low-dose aspirin (75 to 81 mg) is sometimes used for women with an increased risk of thrombosis that does not meet the threshold for prophylactic heparin (e.g., a woman with a mild thrombophilia and no history of VTE).6 Due to the lack of studies of aspirin for this indication, such treatment is of unknown benefit; however, low-dose aspirin is safe to use during pregnancy.32, Postpartum thromboprophylaxis is not routinely indicated following vaginal delivery,42 but may become necessary because of labor-related risk factors, such as prolonged labor, mid-forceps delivery, and immobility after delivery.6, Unless other VTE risk factors are also present, women who undergo a scheduled cesarean delivery are not routinely placed on pharmacologic VTE prophylaxis.44 However, mechanical prophylaxis with pneumatic compression stockings has been shown to provide effective post-cesarean thromboprophylaxis.45 Graduated compression stockings provide effective prophylaxis in nonpregnant postoperative patients.46 A decision analysis comparing pneumatic compression stockings with no intervention for post-cesarean VTE prophylaxis found the former to be cost-effective.47.

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