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Recommendations for the prevention of pregnancy-associated venous thromboembolism

Authors

  • Claire McLINTOCK,

    1. National Women’s Health, Auckland City Hospital, Grafton, Auckland, New Zealand
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  • Tim BRIGHTON,

    1. Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales
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  • Sanjeev CHUNILAL,

    1. Clinical Haematology Department, Monash Medical Centre, Melbourne
    2. Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria
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  • Gus DEKKER,

    1. Discipline of Obstetrics and Gynaecology, University of Adelaide, Lyell McEwin Hospital
    2. Department of Obstetrics and Gynaecology, Women’s and Children’s Hospital, North Adelaide, South Australia
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  • Nolan McDONNELL,

    1. Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, and School of Women’s and Infants’ Health and School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
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  • Simon McRAE,

    1. Department of Haematology, SA Pathology, Royal Adelaide Hospital, Adelaide
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  • Peter MULLER,

    1. Department of Perinatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
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  • Huyen TRAN,

    1. Clinical Haematology Department, Monash Medical Centre, Melbourne
    2. Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria
    3. The Alfred Hospital, Melbourne, Victoria
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  • Barry N.J. WALTERS,

    1. Obstetrics and Gynaecology Clinical Care Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
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  • Laura YOUNG

    1. Department of Haematology, Auckland City Hospital
    2. Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
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Dr Claire McLintock, National Women’s Health, Auckland City Hospital, Level 9, Support Building, Park Rd, Grafton, Private Bag 92024, Auckland 1142, New Zealand. Email: claire.mclintock@adhb.govt.nz

Abstract

Pregnancy is a risk factor for venous thromboembolism (VTE), an important cause of maternal morbidity and mortality. Although there is a 4–5-fold increased risk compared to that of nonpregnant women of the same age, the absolute risk is low at no more than two episodes of VTE per 1000 pregnancies. There is uncertainty about which women require thromboprophylaxis during pregnancy or postpartum because of a lack of data from appropriate clinical trials. For this reason, recommendations for prophylaxis should be made only after explaining the available evidence to the patient and taking into account her perception of the balance of risk and benefit in thromboprophylaxis. The aim of these recommendations is to provide clinicians with practical advice to assist in decisions regarding thromboprophylaxis in women considered to be at risk of VTE during pregnancy and the postpartum. The authors are clinicians from across New Zealand and Australia representing the fields of haematology, obstetric medicine, anaesthesiology, maternal–fetal medicine and obstetrics. Authors were invited to review the relevant literature and then worked collaboratively to devise recommendations and resolve areas of controversy. The recommendations contained herein were reached by consensus and represent the opinion of the panel. The absence of randomised clinical trials in this area limits the strength of evidence that can be used, and it is acknowledged that they represent level C evidence. The panel advocates for appropriate clinical studies to be carried out in this patient population to address the inadequacy of present evidence.

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