Version June 2024
| Antepartum | Postpartum | |
| APS with prior arterial or venous thrombosis, with or without APS-defining pregnancy morbidity | Therapeutic-dose LMWH and low-dose ASA | Warfarin for an indefinite period of time. |
| APS based on laboratory criteria for aPL and APS-defining pregnancy morbidity of ≥1 fetal losses ≥10 weeks of gestation or ≥3 unexplained consecutive spontaneous pregnancy losses <10 weeks of gestation and NO history of arterial or venous thrombosis | Prophylactic-dose LMWH and low-dose ASA | Prophylactic-dose LMWH and low-dose ASA for six weeks, regardless of route of delivery. |
| APS based on laboratory criteria for aPL and APS-defining pregnancy morbidity of ≥1 preterm deliveries of a morphologically normal infant before 34 weeks of gestation due to severe preeclampsia, eclampsia, or other findings consistent with placental insufficiency and NO history of arterial or venous thrombosis | Most cases: Low-dose ASA | Vaginal delivery: Intermittent pneumatic compression and low-dose ASA while in the hospital. Graduated compression stockings and low-dose ASA for six weeks. Cesarean delivery: Prophylactic-dose LMWH and low-dose ASA for six weeks. |
| In cases of ASA failure or when placental examination shows extensive decidual inflammation and vasculopathy and/or thrombosis, prophylactic-dose LMWH with low-dose ASA | Prophylactic-dose LMWH and low-dose ASA for six weeks regardless of route of delivery. | |
| Laboratory criteria for APS but NO clinical criteria for APS (ie, NO history of venous or arterial thrombosis and NO history of APS-defining obstetric morbidity) | Low-dose ASA | Vaginal delivery: Intermittent pneumatic compression and low-dose ASA while in the hospital. Graduated compression stockings and low-dose ASA for six weeks. Cesarean delivery: Prophylactic-dose LMWH and low-dose ASA for six weeks. |
Examples of therapeutic LMWH (also referred to as weight-adjusted, full-treatment dose): enoxaparin 1 mg/kg every 12 hours, dalteparin 200 units/kg once daily, tinzaparin 175 units/kg once daily, dalteparin 100 units/kg every 12 hours.
Examples of prophylactic LMWH: enoxaparin 40 mg SC once daily, dalteparin 5000 units SC once daily, tinzaparin 4500 units SC once daily. These doses may need to be modified at extremes of body weight.
Anticoagulation can generally be resumed 4 to 6 hours after vaginal delivery or 6 to 12 hours after cesarean delivery, unless there is significant bleeding or risk for significant bleeding. Previous neuraxial anesthesia is also a consideration (eg, anticoagulation may be resumed 4 or more hours after catheter removal unless traumatic placement).
NOTE: Tinzaparin is not available in the United States. The role and frequency of anti-Xa testing for management of therapeutic dosing of LMWH in pregnancy are reviewed in the UpToDate topic on anticoagulation in pregnancy. Low-dose aspirin doses range from 75 to 180 mg daily depending on locally available doses. In the United States, one or two 81 mg tablets daily is a common dose.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
