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North American Physician Practice Patterns in the Management of Anticoagulation in Pregnancy. J Womens Health (Larchmt) 2021 06;30(6):829-836

Date

11/25/2020

Pubmed ID

33232187

DOI

10.1089/jwh.2020.8385

Scopus ID

2-s2.0-85108121832

Abstract

Background: During pregnancy and in the postpartum period women are at increased risk of venous thromboembolism (VTE) owing to hypercoagulability and mechanical issues, as well as nonpregnancy conditions including inherited and acquired thrombophilia. Although guidelines exist for the use of thromboprophylaxis in this setting, there are differences in the specifics of the recommendations among expert societies. We assessed the current practice patterns of North American providers in the prevention of pregnancy-associated VTE in women with thrombophilia. Methods: A survey was created and distributed with case studies and questions addressing VTE prevention during the antepartum and postpartum periods. Results: Surveys were completed by 28% of adult providers queried, with broad geographic representation. There was consistent use of a prophylactic dose of low-molecular weight heparin (LMWH) ante- and postpartum for individuals with low-risk thrombophilia and past estrogen-provoked VTE but a lack of a consensus of anticoagulant (AC) use and dose in individuals with higher risk thrombophilia. There was variability in the dose selection and monitoring of AC when using induction versus spontaneous labor, with 47% of providers switching from LMWH to unfractionated heparin for those not having a scheduled delivery, and there were differences in the duration of postpartum prophylaxis based upon delivery mode. Conclusion: In this survey of North American experienced specialists' responses to a variety of commonly encountered scenarios of thrombophilia and pregnancy and the management of AC were not always consistent with published guidelines.

Author List

Cohen AJ, Boggio L, Billett HH, DeSancho MT, Gaddh M, Kouides P, Lim M, Nyak L, Rajan S, Rosovsky R, Streiff M, Wang TF, Baumann Kreuziger L

Author

Lisa M. Baumann Kreuziger MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Anticoagulants
Female
Heparin
Heparin, Low-Molecular-Weight
Humans
North America
Practice Patterns, Physicians'
Pregnancy
Risk Factors
Thrombophilia
Venous Thromboembolism