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● The risk of venous thromboembolism (VTE) is increased during pregnancy and it is highest during puerperium.
● Therapeutic anticoagulation, preferentially with low molecular weight heparins, is indicated at VTE and prophylactically pre- and/or post-partum in women with known persisting prothrombotic factors or with unexplained VTE history. Although they lack formal approval for pregnancy, heparins do not cross placenta and are considered safe based on clinical experience. Monitor factor Xa for the preferred low molecular weight heparins and aPTT for unfractionated ones.
● Heparin therapy should be discontinued 24 hours prior to elective induction of labor but it should be resumed and continued, usually for 6 weeks.
● A longer post-partum thrombopropylaxis can be conducted with vitamin K antagonists, which are compatible with breast feeding. But note that vitamin K antagonists are absolutely contraindicated pre-partum due to early teratogenicity and later due to bleedings reflecting the immaturity of the fetal liver.
● New oral anticoagulants are contraindicated both during pregnancy and breast-feeding due to the lack of clinical experience.
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