Low molecular weight heparin antenatally + 7 days post-partum
M
Warfarin from 12 weeks
Instrunctions:For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
Question 9
A 32 year old woman attends the antenatal clinic at 20 weeks gestation. She is known to be a carrier of the factor V Leiden mutation but has never had a thromboembolic event. Her BMI is 29
1) Very high risk – recurrent VTE associated with antithrombin deficiency or the anti-phospholipid antibody syndrome. Usually on warfarin pre-pregnancy. Require high prophylactic dose (12 hourly) or weight adjusted (75% therapeutic dose) antenatally and for 6 weeks post-partum / until converted to warfarin. Manage with haematologist
2) High risk – previous unprovoked or idiopathic VTE, oestrogen-related VTE, family history of VTE in first degree relative, thrombophilia or other risk factors. Require antenatal LMWH prophylaxis and for 6 weeks post-partum
3) Intermediate risk – VTE provoked by a transient major risk factor that is no longer present and no other risk factors present. No antenatal treatment. Close surveillance to identify risk factors. Post-partum LMWH for 6 weeks.
Posted by Stanley T.
sorry found the answer in the green top guidelines this is all so confusing
asymptomatic thrombophilia is an exception to the rule . if no other risk factors or if it is not one of the severe thrombophilias ( antithrombin,APS, homozygous factor vleiden, homozygous g20210A, or more than 1 or combination of two heterozygoteseg factor v leiden + G20210A)
then close monitoring antenatally but 6 weeks LMWH .
