Clinical setting | Antepartum management | Postpartum management | |
Lower-risk thrombophilia* | With personal history of previous VTE | Unprovoked VTE or VTE associated with a hormonal risk factor: Anticoagulation (low-dose heparin) | Anticoagulation (low-dose heparin) |
VTE associated with a nonhormonal temporary provoking risk factor and no other risk factors for VTE: No antepartum anticoagulation | Anticoagulation (low-dose heparin) | ||
No personal history of VTE | Surveillance for VTE without anticoagulation. Anticoagulation may be warranted for individual patients with additional factors that place them at greater risk of thrombosis (eg, prolonged immobility, first-degree relative with unprovoked VTE under age 50 years). | Anticoagulation (low-dose heparin) for patients who have a cesarean birth | |
Higher-risk thrombophilia¶ | With previous VTE and on long-term anticoagulation | Anticoagulation (therapeutic-dose heparin) | Anticoagulation (therapeutic-dose heparin) |
With previous VTE not on long-term anticoagulation | Anticoagulation (intermediate- or therapeutic-dose heparin) | Anticoagulation (intermediate- or therapeutic-dose heparin) | |
No personal history of previous VTE and not on chronic anticoagulation | Anticoagulation (low- or intermediate-dose heparin) | Anticoagulation (intermediate-dose heparin) |
VTE: venous thromboembolism; FVL: factor V Leiden; PGM: prothrombin G20210A gene mutation; AT: antithrombin.
* Lower-risk thrombophilias include heterozygosity for FVL or PGM and heritable deficiencies of protein C or protein S.
¶ Higher-risk thrombophilias include AT deficiency, homozygosity for FVL or PGM mutation, double heterozygosity for FVL and PGM, and protein C deficiency in combination with another hereditary defect. Some women with heterozygous deficiencies may be at higher risk based on their personal and family history.