Resources

• Guidelines
• UpToDate
• Reviews

My recommendations

Assessment of risk: Thrombophilia, heart valve, High risk PE/cor pulmonale, bleeding complications, thrombocytopenia, concomitant antiplatelets, CKD

Topics to address

1. Anticoagulation agent, dose, and duration - typically LMWH 1mg/kg through 6-12 wks postpartum and/or 3 months total, whichever is longer
2. Anticoagulation management during delivery
   1. Scheduled vs spontaneous - ideally stop 24h before scheduled, but if spontaneous don’t reverse with protamine unless bleeding complications
   2. Neuraxial anesthesia - avoid if LMWH has been given in past 24h, anesthesia consultation pre-delivery if desires epidural
      1. Hold antiplatelets 7-10 days in advance; PLT goals
   3. Reversal
   4. C section - general anesthesia if LMWH <24h
   5. When and how to resume anticoagulation
   6. Prophylaxis
   7. No role for IVC filter unless already in heart failure from PE or cannot be anticoagulated
3. Postpartum anticoagulation and breastfeeding