Why Me, Why Now?
Immediately after delivery considering risk per day.
When is the greatest risk for VTE in pregnancy and the postpartum periods?
The primary treatment for a pregnant woman diagnosed with acute deep vein thrombosis (DVT)
What is Low-molecular-weight heparin (LMWH)?
Pain and swelling in an extremity.
Difference in calf circumference of two or more centimeters.
What are the two most common symptoms of DVT and a physical exam finding suggestive of DVT in a lower extremity?
Reasonable approach to minimize postpartum bleeding complications is resumption of anticoagulation therapy.
What is no sooner than 4-6 hours after vaginal delivery or 6-12 hours after cesarean delivery?
Signs or symptoms suggest new onset DVT. Recommended initial diagnostic test for evaluation.
What is compression ultrasonography of the proximal veins?
Hypercoagulability
Increased Venous Stasis
Decreased Venous OUtflow
Compression of IVC and Pelvic Veins
Decreased Mobility
What are pregnancy-associated physiologic and anatomic changes that increase the risk of VTE?
Enoxaparin, 40 mg SC once daily with modification at extremes of body weight
and
UFH, 5,000-7,500 units SC every 12 hours in first trimester
UFH, 7,500-10,000 units every 12 hours in the second trimester
UFH, 10,000 units SC every 12 hours in the third trimester, unless the aPTT is elevated
What is Prophylactic LMWH and UFH dosing?
Compression ultrasonography of the proximal veins
What is the recommended initial diagnostic test when signs or symptoms suggest new onset DVT?
When reinstitution of anticoagulation therapy is planned postpartum, pneumatic compression devices should be left in pace until.
What is patient is ambulatory and anticoagulation therapy is restarted?
The recommended pregnancy anticoagulants.
What are herapin compounds?
Personal history of thrombosis
Presence of a thrombophilia
What is the most important and next most importance risks factors for VTE in pregnancy?
Enoxaparin, 1 mg/kg every 12 hours
and
UFH, 10,000 units or more SC every 12 hours in doses adjusted to target aPTT in the therapeutic range (1.5-2.5 X control) 6 hours after injection
What is adjusted dose LMHW and UFH?
Left lower iliac and iliofemoral veins.
Where does DVT most likely occur during pregnancy?
Warfarin and LMWH and UH are compatible with breastfeeding for this reason.
What is does not accumulate in breast milk and does not induce an anticoagulant effect in the infant?
LMWH is recommended rather than UH for prevention and treatment of VTE within and outside of pregnancy due to these factors.
What is greater reliability and ease of administration?
Cesarean Delivery
Postpartum Hemorrhage
Obesity
Multiple Gestation
Preeclampsia
What are pregnancy and medical factors that increase the risk of VTE?
Cause potentially harmful fetal effects, especially with first-trimester exposure
What is Warfarin?
Unreliable screening tool in pregnancy to exclude VTE
What is measurement of D-dimer levels?
Placement of pneumatic compression devices before cesarean delivery is recommended for all women. This is also recommended after cesarean.
What is early mobilization?
Women with a history of thrombosis who have not been evaluated for possible underlying etiologies should be tested for the following.
What are antiphospholipid antibodies and inherited thrombophilias?
Fibrinogen
Factor VII
Factor VIII
Factor X
Von Willebrand factor
Plasminogen activator inhibitor-1
Plasminogen activator inhibitor-2
What Procoagulants are increased in pregnancy?
Oral direct thrombin inhibitors (dabigatran) and anti-Xa inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban)
What is cross the placenta and should be avoided in pregnancy?
Ventilation-perfusion (VQ) scan and CT angiography
What are diagnostic tests for new onset PE with relatively low radiation exposure for the fetus?
For women who are receiving prophylactic LMWH, discontinuation is recommended at this time and patient on adjusted dose regiments require this time.
What is 12 hours and 24 hours before scheduled induction of labor?
Adjusted dose therapeutic anticoagulation is recommended for women during pregnancy in this scenario.
What is acute thrombosis or those at high risk of thrombosis such as those with a history of thrombosis or mechanical heart valves?