Anticoagulation management in pregnant patients with inherited thrombophilia involves specialist assessment and tailored thromboprophylaxis. Women with inherited thrombophilia and a history of venous thromboembolism (VTE) should receive pre-pregnancy counselling and a management plan developed in collaboration with a haematologist experienced in thrombosis in pregnancy NICE CKS.
Low molecular weight heparin (LMWH) is the preferred anticoagulant during pregnancy, started as soon as possible when indicated, and continued until the woman is no longer at increased risk of VTE or until discharge from hospital or midwife-led unit NICE NG89.
Warfarin is contraindicated in pregnancy due to teratogenicity and should be stopped before conception, with a switch to LMWH or heparin advised NICE CKS.
For women with recurrent VTE or high-risk thrombophilia, specialist advice is required regarding LMWH dosing, which may need to be higher than standard prophylactic doses NICE CKS.
During labour and delivery, anticoagulation should be managed carefully to balance bleeding and thrombosis risks, often involving multidisciplinary teams including obstetricians and haematologists NICE NG121.
Postpartum thromboprophylaxis with LMWH is recommended, typically for a minimum of 7 days, especially in women with ongoing risk factors NICE NG89.
Key References
- CKS - Pre-conception - advice and management
- NG89 - Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism
- CKS - Deep vein thrombosis
- NG121 - Intrapartum care for women with existing medical conditions or obstetric complications and their babies
- CKS - Pulmonary embolism
- CKS - DVT prevention for travellers