Thromboprophylaxis In Pregnancy: Are Current Guidelines Working?

Thromboprophylaxis in pregnancy poses many challenges for physicians given the potential complications to both mother and fetus. Given the difficulty of enrolling this population in appropriately designed studies, current guidelines rely on results extrapolated from other populations and observational studies. The purpose of this quality assurance project is to examine thromboprophylaxis in pregnancy and ensure that, by following current practice-based guidelines, we are meeting treatment goals by providing therapy that is both safe and efficacious.

A retrospective chart review was completed on all patients between 2008 and 2013 who were treated with prophylactic doses of anticoagulation during their antepartum/postpartum period. Each pregnancy was followed throughout gestation and postpartum to assess for thrombotic events, major bleeding (as per the International Society for Thrombosis and Haemostasis (ISTH) definition), and outcomes.

A total of 44 patients were reviewed. Of these, 21 (48%) met criteria for recurrent miscarriage and 19 (43%) had documented thrombophilia. 19 (43%) had a previous history of VTE, and 18 of the 19 (95%) previous VTE were associated with increased hormonal states. There were no antepartum or postpartum thrombotic events. 4 (9%) patients underwent Doppler ultrasound for clinical suspicion of DVT, but all were negative studies. There were no major bleeding episodes. 15 (34%) patients reported some form of minor bleeding, which did not meet ISTH criteria for major bleeds. Of the 21 pregnancies that met criteria for previous recurrent miscarriage, 15 (71%) had successful term deliveries, 1 (5%) had fetal loss, and 5 (24%) unknown outcomes.

Given the absence of recurrent thrombosis and major bleeding events in the population examined, it would appear that following current practice guidelines is both a safe and efficacious practice.