Chapter 8 - Thromboprophylaxis

Summary

Venous thromboembolism (VTE) is the leading direct cause of maternal mortality in the UK, but many cases are potentially preventable. Risk factors for VTE should be identified pre-pregnancy, or at least early in pregnancy, and reassessed throughout pregnancy and the puerperium, as level of risk may change. Pregnancy itself is a risk factor for VTE, and additional risk factors include previous VTE, thrombophilia, and obesity. Thromboprophylaxis should be introduced depending on the level of risk. Guidelines are given for both ante-natal and post-natal management and in particular for the highest risk period immediately postpartum. Thromboprophylaxis involves both nonpharmacological and pharmacological measures, and the various modalities and drugs that can be used are discussed in this chapter. Non-pharmacological measures include appropriate hydration, early mobilization after surgery or delivery, graduated compression stockings (TEDS), and pneumatic compression boots. Aspirin, heparin, and warfarin are the main pharmacological agents to be used in thromboprophylaxis.