Recommendations for management of pregnancy in polycythemia vera
| Risk stratification: at least 1 of the following defines high-risk pregnancy |
| Previous major thrombotic or bleeding complication |
| Previous severe pregnancy complications* |
| Therapy |
| Low-risk pregnancy |
| Target hematocrit should be kept below 0.45 (45%) |
| Aspirin 100 mg/day |
| LMWH 4000 U/day for the first 6 weeks after delivery |
| High-risk pregnancy |
| As described for low risk, plus: |
| If previous major thrombosis or severe pregnancy complications, LMWH 4000 U/day throughout pregnancy (stop aspirin if bleeding complications). |
| If myelosuppression is required, consider IFN-α† |
| Risk stratification: at least 1 of the following defines high-risk pregnancy |
| Previous major thrombotic or bleeding complication |
| Previous severe pregnancy complications* |
| Therapy |
| Low-risk pregnancy |
| Target hematocrit should be kept below 0.45 (45%) |
| Aspirin 100 mg/day |
| LMWH 4000 U/day for the first 6 weeks after delivery |
| High-risk pregnancy |
| As described for low risk, plus: |
| If previous major thrombosis or severe pregnancy complications, LMWH 4000 U/day throughout pregnancy (stop aspirin if bleeding complications). |
| If myelosuppression is required, consider IFN-α† |
Severe pregnancy complications: at least 3 first-trimester losses or at least 1 second- or third-trimester loss; birth weight lower than the fifth centile of gestation; preeclampsia; intrauterine death; or stillbirth.
Disease-related prior reason for cytotoxic therapy or uncontrolled hematocrit or progressive myeloproliferation (leukocytosis, thrombocytosis, splenomegaly).