Risk Factors
If a DVT occurs during pregnancy it is more likely to occur in this leg due to these reasons
What is the left lower extremity? When DVT occurs in pregnancy, it is more likely to involve the left lower extremity and to be more proximal, involving the iliac and iliofemoral veins. This is attributed to increased venous stasis in the left leg due to compress of the left iliac vein.
These classes of anticoagulants have been studied and found to be safe to use in pregnancy
What is unfractionated heparin and low-molecular weight heparin
This test should be considered first line for diagnosis of DVT
What is compression ultrasound?
It is recommended that you hold prophylactic LMWH for _ hours prior to a scheduled induction or C-S
What are 12 hours?
procoagulant fibrinogen levels (increase/decrease/no change) in pregnancy?
What is increased?
This is the most important risk factor for VTE in pregnancy
What is a personal history of thrombosis? The risk of recurrent VTE in pregnancy increases threefold to fourfold. 15-25% of all cases of VTE in pregnancy are recurrent events.
A patient has a history of a DVT in a prior pregnancy. She is newly pregnant. What is the correct dose of lovenox that she should be started on?
What is 40 mg SC once daily?
Maternal radiation exposure is lower with a (V/Q or CT), whereas fetal radiation exposure is lower with a (V/Q or CT)
Maternal radiation is lower with a V/Q scan, but fetal exposure is lower with a CT.
Therapeutic anticoagulation should be stopped _ hours (if able to be planned)
Von willebrand factor levels in pregnancy (increase/decrease/no change)
What is increase
Thrombophilias are present in this percentage of women who experience VTE in pregnancy and the postpartum period.
What is 20-50%
A 32 yo G2P1 at 32 weeks gestation is diagnosed with a popliteal DVT. She weighs 70 kg. What is the correct dosing of LMWH for her?
What is 70 mg every 12 hours?
What levels of anti-Xa do you aim for?
It is recommended for a patient on prophylactic LMWH to restart their anticoagulation _ hours after placement of the epidural and _ hours after catheter removal.
What are 12 and 4 hours?
Levels of protein S in pregnancy (increase/decrease/no change)
Cesarean deliveries increase your risk of VTE _-fold
What is fourfold?
Because of these reasons, higher doses of heparin are needed during pregnancy when compared to non-pregnancy dosing
What is: increase in maternal blood volume, increase in glomerular filtration which increases renal excretion and increased protein binding of heparin.
Heparin has shorter half-lives and lower peak plasma volumes.
If a patient is high risk and hospitalized with high likelihood of delivery it may be advised to switch them to this anticoagulation method so as to decrease their potential risk of...
What is unfractionated heparin and spinal hematoma
If patient is on unfractionated heparin, it is recommended to wait _ hours after catheter removal before restarting anticoagulation
What is 1 hour?
Levels of protein C in pregnancy (increase/decrease/no change)
What is no change
These intrapartum events can increase your risk of VTE (2)
A 27 yo delivers precipitously at Grady with no prenatal care. Her infant had low birth weight and did not pass newborn screening. Years later you would find out that this infant had slower growth, mental retardation, deafness, small head size, and malformed bones, cartilage, and joints. What medication did Mom take during pregnancy? What is this syndrome called? What is the only indication to take this medication during pregnancy?
What is warfarin, warfarin embryopathy and mechanical heart valves?
If patients are converted from LMWH to unfractionated heparin, checking these levels might help maintain therapeutic range
What are aPTT levels?
What can you give to reverse unfractionated heparin?
What is protamine sulfate?
Antithrombin levels in pregnancy (increase/decrease/no change)
What is no change